Pediatric Transplantation最新文献

{"title":"Effect of Pediatric Heart Transplant Waitlist Inactivation on Waitlist and Posttransplant Outcomes.","authors":"Dean S Karahalios, Christina Laternser, Philip Thrush, Adam Morrison, Michael Mongé, Defne A Magnetta","doi":"10.1111/petr.70454","DOIUrl":"10.1111/petr.70454","url":null,"abstract":"<p><strong>Background: </strong>Little is known about pediatric heart transplant candidates facing waitlist inactivation. We characterized them and assessed the impact of inactivation on waitlist and transplant outcomes.</p><p><strong>Methods: </strong>The Organ Procurement and Transplantation Network database was queried for pediatric heart-only transplant candidates. Characteristics, waitlist mortality, and 1-year posttransplant survival between inactivated and non-inactivated patients were compared. Predicted probability for the composite outcome of waitlist mortality or removal due to clinical deterioration over time was computed.</p><p><strong>Results: </strong>Of 5202 patients, 1716 (33%) were inactivated, mostly due to temporary illness (58%). Reasons for inactivation varied by age but not diagnosis. Inactivated patients had longer waitlist duration (171 [77-391] vs. 62 [21-144], p < 0.001), more congenital heart disease (61.0% vs. 55.2%, p < 0.001), and were more often supported by ventricular assist device (47.9% vs. 32.9%, p < 0.001) and invasive ventilation at listing (19.9% vs. 13.6%, p < 0.001). Inactivated patients were less likely listed Status 1A (56.8% vs. 62.3%, p < 0.001) and less likely under intensive care at transplant (43.9% vs. 50.2%, p < 0.001). Inactivated patients had higher 1-year waitlist mortality and removal due to clinical deterioration (SHR 4.40 [3.72-5.20], p < 0.001), though this risk decreased with longer inactive time. One-year posttransplant survival was similar between groups.</p><p><strong>Conclusions: </strong>Waitlist inactivation was strongly associated with 1-year waitlist mortality and removal due to clinical deterioration. However, this risk decreased with longer inactive time and made no difference in short-term posttransplant survival. Thus, the prognostic implications of inactivation are dynamic and can inform future donor allocation policy development.</p>","PeriodicalId":20038,"journal":{"name":"Pediatric Transplantation","volume":"30 9","pages":"e70454"},"PeriodicalIF":1.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13575578/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148970730","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction to \"Terlipressin Therapy for Portal Hyperperfusion Secondary to Portal Vein Size Discrepancy After Pediatric Liver Transplant\".","authors":"","doi":"10.1111/petr.70399","DOIUrl":"10.1111/petr.70399","url":null,"abstract":"","PeriodicalId":20038,"journal":{"name":"Pediatric Transplantation","volume":"30 9","pages":"e70399"},"PeriodicalIF":1.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13579608/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148977443","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hospitalization Costs of Kidney Transplantation Associated With Induction Therapy Among Pediatric Kidney Transplant Recipients: A North American Pediatric Renal Trials and Collaborative Studies and Pediatric Health Information System Collaborative Study.","authors":"Nancy M Rodig, Daniella Levy Erez, Helen P Pizzo, Troy Richardson, Michael J Somers","doi":"10.1111/petr.70441","DOIUrl":"10.1111/petr.70441","url":null,"abstract":"<p><strong>Background: </strong>Choice of induction agent at the time of pediatric kidney transplantation is primarily influenced by recipient characteristics and center practice. The economic implications of this choice have not been reported in a pediatric cohort.</p><p><strong>Methods: </strong>This is a retrospective study of merged data from North American Pediatric Renal Trials and Collaborative Studies transplant registry with data in the Pediatric Health Information Systems. We estimated costs of the kidney transplant admission analyzed for association with induction agent and clinical factors. Participants were grouped by induction agent: interleukin-2 receptor blocker (IL2RB), anti-thymocyte globulin (ATG), and alemtuzumab. We also estimated inpatient care and other hospital-based services during the first year after transplantation.</p><p><strong>Results: </strong>A total of 831 children and young adults < 21 years who received a kidney transplant between January 2010 through 2019 were identified. Among these, 50.5% received ATG, 31.3% received IL2RB only, and 18.2% received alemtuzumab. Among clinical characteristics studied, sex and likelihood of pre-emptive transplant were similar among the groups. Though unadjusted index hospitalization costs (IHC) were significantly different among the induction groups, induction choice was not associated with IHC in multivariable analysis. Younger age at the time of transplantation and delayed graft function (DGF) were independently associated with higher IHC. Unadjusted hospital-based costs incurred after discharge from the transplant procedure through the first year after transplantation were similar among induction groups.</p><p><strong>Conclusion: </strong>Among pediatric and young adult kidney transplant recipients, IHC was comparable across induction agents. Younger age at transplantation and DGF were associated with significantly higher IHC.</p>","PeriodicalId":20038,"journal":{"name":"Pediatric Transplantation","volume":"30 9","pages":"e70441"},"PeriodicalIF":1.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13555108/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148912545","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Non-HLA Antibody-Associated Hyperacute Allograft Rejection Following Lung Transplantation.","authors":"Justyna A Karolak, Ernestina Melicoff, Nidhy P Varghese, Przemyslaw Szafranski, Esra Yıldız Bölükbaşı, Erin E McHugh, Sarah Nicholas, Peter Jindra, John Hicks, Eric D Austin, Paweł Stankiewicz, George B Mallory","doi":"10.1111/petr.70457","DOIUrl":"10.1111/petr.70457","url":null,"abstract":"<p><strong>Background: </strong>Pediatric-onset pulmonary hypertension (PH) is a rare, progressive pulmonary vascular disease associated with high mortality. In cases unresponsive to pharmacological therapy with a severe cardiorespiratory phenotype, lung transplantation (LT) remains the final treatment option. Although LT for pediatric PH is considered a procedure with elevated risk, it has been successfully performed in this population.</p><p><strong>Case presentation: </strong>A 3-year-old boy underwent uncomplicated LT for fulminant TBX4-associated PH and developed hyperacute allograft failure requiring plasmapheresis, augmentation of immunosuppression, and the use of a monoclonal complement inhibitor. Despite extensive treatment the patient died 46 days after LT. Retrospective analysis of the serum sample taken at time of transplant prior to reperfusion was positive for six non-histocompatibility antibodies: Sjogren syndrome antigen B, thyroglobulin, glutathione S-transferase Theta-1, colony stimulating factor 2, intracellular adhesion molecule 1, and interferon gamma that were not present in other pediatric thoracic transplant recipients.</p><p><strong>Conclusions: </strong>Hyperacute allograft rejection is extremely rare in LT recipients and its occurrence in this patient implies the need for further characterization of non-HLA antibody-associated LT rejection.</p>","PeriodicalId":20038,"journal":{"name":"Pediatric Transplantation","volume":"30 9","pages":"e70457"},"PeriodicalIF":1.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13599712/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149025831","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unilateral Versus Bilateral Native Nephrectomy in Pediatric Kidney Transplant.","authors":"William Law, Kereen Constant, Patrick Delaplain, Gheed Murtadi, Steven Staffa, Eliza Lee, Heung Bae Kim, Isa Ashoor, Arin Madenci, Alex G Cuenca","doi":"10.1111/petr.70465","DOIUrl":"https://doi.org/10.1111/petr.70465","url":null,"abstract":"<p><strong>Background: </strong>Nephrectomy in pediatric kidney transplantation is still practiced routinely at some institutions. Despite this, the clinical utility of nephrectomy for certain indications such as proteinuria and hypertension on pre- and post-transplant outcomes is unknown.</p><p><strong>Methods: </strong>All children who underwent kidney transplant and native nephrectomy between 2009 and 2025 were reviewed for baseline clinical covariates, operative details, and outcomes.</p><p><strong>Results: </strong>Of the study population, 70 patients underwent unilateral nephrectomy and 61 underwent bilateral nephrectomy. The median age at transplant in the unilateral nephrectomy group was 12.5 years [9.3, 15.9] vs. 10.7 [7.1, 14.1] in the bilateral nephrectomy group. Operative time was 351.5 [294.8, 413.8] minutes vs. 353 [292, 420], median hospital length of stay 8 days [7, 11] vs. 11 days [8, 16], complications 8 (11%) vs. 15 (25%), and post-transplant delayed graft function 4 patients (6%) vs. 7 (12%). Rejection occurred in 1 patient per group. In the 18 patients who had a nephrectomy for proteinuria, the change in albumin was similar between groups (0.4 g/dL [-0.1, 0.4] vs. 0 g/dL [-0.2, 0.2]). In the 23 patients who had a nephrectomy for hypertension, the change in antihypertensive medications after transplant was higher in the unilateral nephrectomy group (1.5 medications less [0.8, 2] vs. 0 [0, 1]).</p><p><strong>Conclusions: </strong>For the indications of proteinuria and hypertension, clinical outcomes were similar between bilateral vs. unilateral nephrectomy for individuals who underwent kidney transplantation. These findings support consideration of pursuing fewer bilateral native nephrectomies in these patient populations.</p>","PeriodicalId":20038,"journal":{"name":"Pediatric Transplantation","volume":"30 9","pages":"e70465"},"PeriodicalIF":1.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149040162","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of Perioperative Management on Short-Term Renal Transplant Outcome: A Retrospective Cohort Study.","authors":"Nai-Wei Wang, Matthias Görges, Myles Cassidy, Tom Blydt-Hansen","doi":"10.1111/petr.70434","DOIUrl":"10.1111/petr.70434","url":null,"abstract":"<p><strong>Background: </strong>There are limited data on how intraoperative hemodynamic factors influence pediatric kidney transplant outcomes, particularly across the different phases of graft reperfusion. With the widespread introduction of anesthesia information management systems, new opportunities have emerged to explore how intraoperative management affects transplant outcomes.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study at a single center, including transplant recipients under 19 years of age who underwent kidney transplantation between 2010 and 2022 (n = 121). Data were extracted from chart reviews, anesthesia records, and an intraoperative monitoring databank. Modeling for clinical variables alone, intraoperative variables alone, and combined clinical-intraoperative features was analyzed with respect to three outcomes: Unadjusted glomerular filtration rate at one-month post-transplant (uGFR_1M), time to creatinine nadir, and length of hospital stay.</p><p><strong>Results: </strong>Longer duration of pre-unclamp mean arterial pressure (MAP) below the 95th percentile (β = -0.086, p = 0.009), a greater number of inotropes used during the pre-unclamp period (β = -4.00, p = 0.017), and higher MAP variability in the first 30 min post-unclamp (β = -1.38, p = 0.006) were each independently associated with lower uGFR_1M. A greater volume of fluid administered in the pre-unclamp period was independently associated with a longer time to creatinine nadir (β = 0.002, p = 0.01).</p><p><strong>Conclusions: </strong>Intraoperative features related to pre-unclamp volume resuscitation, MAP control, and post-unclamp hemodynamic instability are associated with slower graft function in pediatric kidney transplantation.</p>","PeriodicalId":20038,"journal":{"name":"Pediatric Transplantation","volume":"30 9","pages":"e70434"},"PeriodicalIF":1.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13543051/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148892413","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Annual Protocol Biopsies for Five Years in a Pediatric Kidney Transplant Program: A Single-Center Retrospective Experience.","authors":"İlke Taşkırdı, Belde Kasap-Demir, Caner Alparslan, Eren Soyaltın, Seçil Aslansoyu-Çamlar, Demet Alaygut, Fatma Mutlubaş, Cem Tuğmen, Önder Yavaşcan","doi":"10.1111/petr.70464","DOIUrl":"https://doi.org/10.1111/petr.70464","url":null,"abstract":"<p><strong>Background: </strong>Annual protocol biopsies may detect subclinical injury after pediatric kidney transplantation, but real-world five-year surveillance coverage and clinical yield are uncertain. We assessed coverage, histological yield, management consequences, and histology-function associations.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study of all 42 consecutive pediatric kidney transplant recipients transplanted between 2007 and 2017 and followed in a single pediatric nephrology program with annual surveillance biopsies. Analyses were based on accrued recipient-year surveillance opportunities; biopsies performed at scheduled times for a clinical indication were excluded from protocol-biopsy analyses. A random-intercept mixed-effects model related estimated glomerular filtration rate (eGFR) to a study-specific chronicity composite score and post-transplant year.</p><p><strong>Results: </strong>Of 158 accrued surveillance opportunities, a protocol biopsy was attempted at 123 (77.8%); 94/158 (59.5%) opportunities in 36 recipients yielded evaluable histology. Abnormal findings occurred in 15/94 (16.0%) evaluable results, involving 10 recipients, and 4/15 (26.7%) were followed by a documented biopsy-driven management change. Seven abnormalities in years 1-2 occurred in seven different recipients, whereas all eight abnormalities in years 3-5 were confined to three recipients with consecutive abnormal biopsies. Higher chronicity scores were associated with lower concurrent eGFR (β = -4.49 mL/min/1.73 m² per score point; 95% CI, -7.16 to -1.82; p = 0.001).</p><p><strong>Conclusions: </strong>Real-world surveillance coverage and interpretable yield were incomplete, and documented management impact was limited. These data do not establish a benefit of uniform annual surveillance and provide a rationale for prospective evaluation of risk-adapted strategies.</p>","PeriodicalId":20038,"journal":{"name":"Pediatric Transplantation","volume":"30 9","pages":"e70464"},"PeriodicalIF":1.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149002239","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Donor-Recipient Size Mismatch, Age at Transplant, and Elevated Donor-Derived Cell-Free DNA % Early After Pediatric Heart Transplant.","authors":"Alice M Tao, Irene D Lytrivi, Aine Lynch, Jenna Schauer, Teresa M Lee, Sabrina Law, Marc Richmond, Warren Zuckerman","doi":"10.1111/petr.70461","DOIUrl":"https://doi.org/10.1111/petr.70461","url":null,"abstract":"<p><strong>Background: </strong>Acute rejection (AR) is a major cause of graft loss after orthotopic heart transplant (OHT). Donor-derived cell-free DNA fraction (dd-cfDNA%) is a noninvasive biomarker for AR but may be elevated without AR. We evaluated associations of donor-recipient size mismatch and recipient age with early dd-cfDNA% in pediatric OHT recipients without AR.</p><p><strong>Methods: </strong>This single-center retrospective study evaluated initial dd-cfDNA% testing in pediatric OHT recipients without AR. Size mismatch was assessed using donor-to-recipient body surface area (BSA) ratio, weight ratio, and allograft left ventricular (LV) mass z-score. Associations with dd-cfDNA% were assessed using Spearman correlation and Mann-Whitney U tests; multivariable linear regression adjusted for age. Analyses of size mismatch and recipient age were repeated at the second post-OHT dd-cfDNA assessment.</p><p><strong>Results: </strong>Between 2022 and 2025, 58 pediatric OHT recipients underwent dd-cfDNA% testing; 39 had no rejection. After excluding 2 outliers, 37 remained. Higher first dd-cfDNA% was associated with larger BSA ratio (p = 0.039), BSA ratio ≥ 1.5 (median 0.17% vs. 0.06%, p = 0.0185), larger weight ratio (p = 0.016), LV mass oversizing (median 0.17% vs. 0.06%, p = 0.0196), and younger age (p = 0.008). After age adjustment, neither size mismatch nor age was independently associated with first dd-cfDNA%. No significant associations were observed at the second assessment.</p><p><strong>Conclusions: </strong>Greater donor-recipient size mismatch and younger recipient age were associated with higher first dd-cfDNA% in unadjusted analyses, but not after age adjustment. These exploratory findings support further investigation of size mismatch, recipient age, and early allograft adaptation as potential non-rejection contributors to dd-cfDNA elevation.</p>","PeriodicalId":20038,"journal":{"name":"Pediatric Transplantation","volume":"30 9","pages":"e70461"},"PeriodicalIF":1.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149002228","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Antimicrobial Prophylaxis in Pediatric Transplantation: From Describing Heterogeneity to Reducing It.","authors":"Renato Gualtieri, Arnaud G L'Huillier","doi":"10.1111/petr.70450","DOIUrl":"10.1111/petr.70450","url":null,"abstract":"","PeriodicalId":20038,"journal":{"name":"Pediatric Transplantation","volume":"30 9","pages":"e70450"},"PeriodicalIF":1.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13563199/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148930731","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transmission of Anellovirus From Kidney-Donor to Pediatric Recipient: An Exploratory Study.","authors":"Luna S Klomp, Maarten G J M Burggraaff, Margreet Bakker, Michel Molier, Anne L Timmerman, Martin Deijs, Mariet Feltkamp, Lia van der Hoek, Antonia H M Bouts","doi":"10.1111/petr.70448","DOIUrl":"10.1111/petr.70448","url":null,"abstract":"<p><strong>Background: </strong>Among the most abundant viruses in the human blood virome are anelloviruses, including alpha-, beta-, and gammatorqueviruses (TTV, TTMV, and TTMDV). Whether anelloviruses are transmitted through kidney transplantation at a young age and subsequently persist in their new host is unknown. This study investigates the dynamics and composition of the anellome in the blood of six pediatric donor-recipient pairs, with monitoring beginning before transplantation and continuing until 2 years after transplantation.</p><p><strong>Methods: </strong>Donors were sampled once, before donation, while recipients were sampled before and multiple times after transplantation (median 6.5 samples). Quantitative PCR, rolling circle amplification, Illumina sequencing, and SCANellome V2 analysis were used to detect, characterize, and compare anellovirus presence in donors and recipients.</p><p><strong>Results: </strong>At baseline, four out of six donors tested positive for TTV by quantitative anellovirus PCR, three of whom had sufficient viral loads to enable genomic comparison with their recipients. All recipients tested positive at baseline, five had a moderate viral load (< 10⁵ copies/mL), and one had > 10⁹ copies of TTV DNA/mL. This recipient was already immunosuppressed before transplantation, and only in this recipient was a donor-derived anellovirus identified. This lineage was detected among 15 other lineages in the recipient and matched one of the four lineages identified in the donor.</p><p><strong>Conclusion: </strong>This finding demonstrates that anellovirus transmission from donor to recipient occurs in pediatric kidney transplantation. This may be associated with pre-existing immunosuppression.</p>","PeriodicalId":20038,"journal":{"name":"Pediatric Transplantation","volume":"30 9","pages":"e70448"},"PeriodicalIF":1.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13536503/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148875143","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}