Pediatric Transplantation最新文献

{"title":"An Approach to Antibody-Mediated Rejection in Pediatric Liver Transplantation.","authors":"Catalina Jaramillo, Parmjeet Randhawa, Amrita Narang, Alison J Gareau, Jody Weckwerth, Alisha Mavis, George Mazariegos, Katryn Furuya, Nanda Kerkar","doi":"10.1111/petr.70455","DOIUrl":"10.1111/petr.70455","url":null,"abstract":"<p><p>Antibody-mediated rejection (AMR) is an important but infrequent cause of pediatric liver allograft injury. There is a lack of standardized guidance, and treatment approaches vary across institutions. A writing group from the Society of Pediatric Liver Transplantation conducted a comprehensive review of the published literature and collected institutional guidance documents from pediatric transplant centers across the United States to synthesize current diagnostic and management approaches to AMR in pediatric liver transplant recipients. AMR is diagnosed by the presence of characteristic histologic injury, C4d deposition, circulating donor-specific antibody (DSA), and exclusion of alternative causes of graft dysfunction, including T cell-mediated rejection. Management strategies focus on reducing circulating DSA through therapeutic plasma exchange and suppressing ongoing immune activation with corticosteroids and intravenous immunoglobulin. In severe or refractory cases, targeted therapies such as rituximab, bortezomib, and eculizumab may be considered. A stepwise diagnostic and management algorithm is presented. This resource outlines a practical approach to the diagnosis and management of AMR in pediatric liver transplantation, serving as a reference for busy clinicians who may encounter this serious but underrecognized cause of graft dysfunction and loss.</p>","PeriodicalId":20038,"journal":{"name":"Pediatric Transplantation","volume":"30 9","pages":"e70455"},"PeriodicalIF":1.4,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13552086/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148906843","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":"Alemtuzumab Induction via Intravenous vs. Subcutaneous Administration in Pediatric Kidney Transplantation.","authors":"H Pizzo, A Barbera, K Westreich, M E Seifert, J Mirocha, K Kirshner, D Puliyanda","doi":"10.1111/petr.70424","DOIUrl":"10.1111/petr.70424","url":null,"abstract":"<p><strong>Background: </strong>Alemtuzumab is an induction immunosuppressive agent effective in preventing hyperacute rejection; however, it can result in prolonged lymphocyte depletion. Here we assessed the dosing, tolerability, and outcomes with alemtuzumab induction via IV vs. SQ route in pediatric kidney transplantation.</p><p><strong>Methods: </strong>A multicenter analysis of 119 patients < 21 years old who received alemtuzumab induction immunosuppression. Total dose (mg) and dose by body weight (mg/kg) were assessed. Tolerability was defined by the development of leukopenia (WBC < 3.0 × 10³/uL) or neutropenia (ANC < 1.5 × 10³/uL). Outcomes in the first year post-transplant were defined by eGFR, hospitalizations, infections, development of de novo DSA, and rejection.</p><p><strong>Results: </strong>A total of 83 and 36 recipients received alemtuzumab IV and SQ, respectively. SQ group was slightly older, 14.0 y. (SD 5.5) vs. 11.9 y. (SD 6.1) (p = 0.07), and had more highly sensitized recipients, 14 (38.9%) vs. 10 (12.1%) (p = 0.002). Total dose and dose by weight were higher in the SQ group, 22.3 mg (SD 8.9) vs. 14.9 mg (SD 9.5), and 0.57 mg/kg (SD 0.21) vs. 0.36 mg/kg (SD 0.18 mg), respectively (p = 0.0001 and p < 0.0001). SQ group experienced more leukopenia and resultant medication dose reduction; however, there were no differences between the groups in eGFR, infections, hospitalizations, and rejection in the year following transplant.</p><p><strong>Conclusion: </strong>Despite the higher dose of alemtuzumab and rates of leukopenia in the SQ group, there were no other differences in tolerability and outcomes compared to IV alemtuzumab. Overall, alemtuzumab is well tolerated during the first year post-transplant as an induction immunosuppression agent in the pediatric population.</p>","PeriodicalId":20038,"journal":{"name":"Pediatric Transplantation","volume":"30 8","pages":"e70424"},"PeriodicalIF":1.4,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13469996/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148721869","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":"How Well Do \"Dr. Google\" and \"Professor YouTube\" Answer Health Questions for Pediatric Kidney Transplant Recipients and Caregivers?","authors":"Ashley Burghall, Ryan R D Chan, Nicola Rosaasen, Tom D Blydt-Hansen, Laura Beresford, Allison Cammer, Keefe Davis, Kayla Flood, Aviva Goldberg, Lorraine Hamiwka, Kathryn Haubrich, Camille Laroche, Véronique Phan, Michelle Ruhl, Chia Wei Teoh, Jenny Wichart, Holly Mansell","doi":"10.1111/petr.70409","DOIUrl":"10.1111/petr.70409","url":null,"abstract":"<p><strong>Background: </strong>Pediatric kidney transplant recipients and their caregivers require comprehensive education to support self-management. Increasingly, families supplement clinic teaching with online platforms such as Google and YouTube, yet the quality, readability, and usefulness of these resources are uncertain.</p><p><strong>Methods: </strong>Structured searches on Google and YouTube were conducted using patient-style questions and medically oriented key terms across four prioritized topics: healthy eating, exercise, travel, and mental health. Resources were screened for relevance and assessed for accuracy, completeness (defined as including all key facts needed to support recommendations), readability, and actionability (defined as providing clear, practical steps users can follow). Two pediatric transplant healthcare providers independently reviewed each resource. Two researchers assessed understandability and actionability using the Patient Education Materials Assessment Tool (PEMAT), and readability using multiple readability tools.</p><p><strong>Results: </strong>Searches yielded 87 Google and 41 YouTube resources; most targeted adult transplant recipients. Healthcare providers assessed 65% of Google and 68% of YouTube resources to be accurate, but only 18% and 5% were factually complete. Actionable recommendations were identified in 42% (Google) and 29% (YouTube). Readability ranged from grade 5 to 17, with only 6 of 82 Google resources meeting the recommended grade 6 or lower. Mean understandability scores were 67% for both platforms. Actionability scores averaged 39% (Google) and 77% (YouTube). Resources suitable for pediatric audiences (n = 28) had similar readability and understandability scores but slightly higher actionability (Google: 43%, YouTube: 81%). Most resources lacked pediatric focus, co-creation, and practical guidance.</p><p><strong>Conclusions: </strong>Online searches generated limited high-quality resources tailored to pediatric needs. Healthcare providers should guide families to vetted resources and consider co-creating materials to improve relevance and impact.</p>","PeriodicalId":20038,"journal":{"name":"Pediatric Transplantation","volume":"30 8","pages":"e70409"},"PeriodicalIF":1.4,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13458959/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148707523","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":"Proximal Roux-en-Y Limb Intussusception After Pediatric Living Donor Liver Transplantation for Biliary Atresia: A Rare Surgical Emergency.","authors":"Peng Cai, Seisuke Sakamoto, Hajime Uchida, Chanokkamol Kiataramkul, Ayane Oshiro, Masato Kojima, Ryuji Komine, Yusuke Yanagi, Akinari Fukuda, Mureo Kasahara","doi":"10.1111/petr.70439","DOIUrl":"10.1111/petr.70439","url":null,"abstract":"<p><strong>Background: </strong>Intussusception of the Roux-en-Y limb after pediatric liver transplantation (LT) is an extremely rare but potentially life-threatening complication. Altered anatomy, postoperative adhesions, and disrupted intestinal motility create a unique pathophysiological environment, which may delay diagnosis and increase morbidity.</p><p><strong>Methods: </strong>We retrospectively analyzed a patient with acute intestinal obstruction after living donor liver transplantation. Clinical presentation, laboratory findings, imaging results, intraoperative observations, surgical management, and outcomes were reviewed. The potential pathogenesis was explored in relation to factors such as Roux-en-Y reconstruction, graft-to-recipient size ratio, and postoperative adhesive disease.</p><p><strong>Results: </strong>The patient presented with fever and melena. Laboratory evaluation revealed leukocytosis and severe anemia. Computed tomography demonstrated small bowel intussusception with obstruction. Emergency laparotomy identified intussusception of the proximal Roux limb near the biliary-enteric anastomosis. Manual reduction was unsuccessful, necessitating segmental resection without reconstruction of a new Roux limb. Extensive intra-abdominal adhesions were noted. Postoperative recovery was uneventful, and graft function remained stable.</p><p><strong>Conclusions: </strong>Intussusception of the Roux-en-Y limb following pediatric living donor liver transplantation is a complex surgical emergency. This case demonstrates that in the transplant population, symptoms such as fever and melena should trigger immediate cross-sectional imaging to rule out mechanical obstruction. The management strategy must be aggressive yet conservative regarding anatomical disruption. As the population of long-term pediatric transplant survivors grows, recognizing these distinct mechanistic patterns is essential for reducing morbidity and mortality.</p>","PeriodicalId":20038,"journal":{"name":"Pediatric Transplantation","volume":"30 8","pages":"e70439"},"PeriodicalIF":1.4,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13501217/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148808596","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":"Interventional Radiology Management After Early Hepatic Artery Thrombosis Following Pediatric Liver Transplantation.","authors":"Mercadal-Hally Maria, Pérez Mercedes, Molino José Andrés, Barnés Daniel, Caralt Mireia, Dalmau Mar, Díez Iratxe, Dopazo Cristina, Gómez-Gavara Concepción, González Carla, Juamperez Javier, Mameli Simone, Miserachs Mar, Muyo Paula, Ortega Juan, Padrós Cristina, Sapisochin Gonzalo, Hidalgo Ernest, Quintero Jesús","doi":"10.1111/petr.70423","DOIUrl":"https://doi.org/10.1111/petr.70423","url":null,"abstract":"<p><strong>Background: </strong>Hepatic artery complications are a major cause of early graft loss after liver transplantation (LT), especially in pediatric patients. Traditionally, these complications have been managed with surgical reintervention. This study presents the outcomes of early radiological intervention in pediatric LT patients with early hepatic artery thrombosis (HAT).</p><p><strong>Methods: </strong>A retrospective analysis was conducted by reviewing the prospectively collected database in our center. Patients between 0 to 18 years of age who had received an LT between 2003 and 2024 and had presented HAT in the first month after LT were included.</p><p><strong>Results: </strong>Out of 340 LTs, 13 patients (3.8%) presented early HAT and underwent an interventional radiology procedure (IRP) with balloon dilation and local infusion of vasodilators and/or fibrinolytic drugs. Five patients also required stent placement. The median time from LT to IRP was 1 day (0-6.5). IRP primary technical success was achieved in 11 of 13 patients (84.6%). Hepatic artery patency at three months was achieved in 10/13 (76.9%) of our patients, whilst long-term hepatic artery patency was achieved in 8/13 (61.5%) patients. Two patients ultimately required retransplantation.</p><p><strong>Conclusions: </strong>An early and proactive interventional radiology approach may represent a feasible option for managing early HAT after pediatric LT. When performed promptly after diagnosis, it can help preserve hepatic artery patency and potentially reduce the need for surgical intervention and retransplantation.</p>","PeriodicalId":20038,"journal":{"name":"Pediatric Transplantation","volume":"30 8","pages":"e70423"},"PeriodicalIF":1.4,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13491247/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148796536","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":"Living Donor Liver Transplantation in Pediatric Situs Inversus: A Case Series and Systematic Review.","authors":"Maria F Fernandez, Nadia Ali, Carolina Rumbo, Piyush Gupta, Kathryn LaRusso, Nada Yazigi, Christof Kaltenmeier, Juan F Guerra, Leonardo A Montes, Udeme Ekong, Alexander Kroemer, Dolores Garcia-Hervas, Khalid Khan, Yuri Genyk, Cal Matsumoto, Julio Trentadue, Diego Ramisch, Pablo Barros-Schelotto, Thomas Fishbein, Gabriel E Gondolesi","doi":"10.1111/petr.70425","DOIUrl":"10.1111/petr.70425","url":null,"abstract":"<p><p>Liver transplantation (LT) in patients with situs inversus (S-I) is rare and technically challenging. The literature on such cases, particularly in pediatric populations, remains limited. Here, we report the surgical considerations and outcomes of two pediatric recipients with situs inversus abdominalis who underwent liver transplantation for biliary atresia (BA). We conducted a retrospective descriptive analysis of two pediatric patients with S-I who underwent LT for BA. Pretransplant imaging, intraoperative details, and posttransplant outcomes were evaluated. Additionally, we performed a systematic review of the literature on LT in patients with S-I. We describe the successful living donor liver transplantation (LDLT) of two pediatric patients with S-I abdominalis and BA, each presenting with complex anatomical variations, including polysplenia, intestinal malrotation, and vascular anomalies such as absence of the inferior vena cava (IVC). Both patients underwent technically demanding procedures requiring customized vascular and biliary reconstructions, along with definitive correction of intestinal malrotation to restore anatomical intestinal orientation. Both patients had an uncomplicated immediate postoperative course. During follow-up, one patient developed a diaphragmatic hernia that required surgical repair. Our systematic review confirms that, although rare, pediatric LT in patients with S-I is increasingly reported with favorable outcomes. These findings support the feasibility and safety of LT in children with S-I when guided by meticulous preoperative planning and intraoperative adaptability. Liver transplantation in pediatric patients with S-I is feasible and can be performed safely with careful preoperative planning and tailored surgical techniques. Our experience, together with the available literature, supports the inclusion of these patients as suitable candidates for transplantation despite their complex anatomy.</p>","PeriodicalId":20038,"journal":{"name":"Pediatric Transplantation","volume":"30 8","pages":"e70425"},"PeriodicalIF":1.4,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13451611/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148689695","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":"Angiotensin Type 1 Receptor Antibody Positivity in a Pediatric Liver Transplant Patient With Antibody-Mediated Rejection: A Case Report.","authors":"Tanya Su, Peter T Jindra, John Hicks, Deborah Schady, Dana Cerminara, Sarah K Nicholas, John A Goss, Nhu Thao Galvan, Krupa R Mysore","doi":"10.1111/petr.70413","DOIUrl":"10.1111/petr.70413","url":null,"abstract":"<p><strong>Background: </strong>Antibody-mediated rejection (AMR) in pediatric liver transplantation (LT) is uncommon and poorly understood. While human leukocyte antigen (HLA) antibodies are usually implicated in AMR, non-HLA antibodies have also been reported.</p><p><strong>Methods: </strong>We describe a 7-year-old female with non-HLA AMR in the setting of positive angiotensin type 1 receptor (AT1R) antibodies.</p><p><strong>Results: </strong>She was diagnosed with acute T-cell mediated rejection (TCMR) 6 months post-LT which was treated with intravenous methylprednisolone (IVMP) but had minimal response. A repeat biopsy revealed features of AMR including C4d staining and capillaritis, but donor-specific antibodies (DSAs) were negative. However, AT1R antibodies were elevated at 21 U/mL. She received antithymocyte globulin (ATG) and was started on losartan to block AT1R antibodies, with excellent response.</p><p><strong>Conclusion: </strong>While the recognition and mechanisms of AMR in pediatric LT are in its infancy, this case highlights the importance of considering non-HLA antibodies as potential mediators of AMR. Children who fail to respond to TCMR treatment should be evaluated for AMR by obtaining DSAs, C4d staining on biopsy, and non-HLA antibodies.</p>","PeriodicalId":20038,"journal":{"name":"Pediatric Transplantation","volume":"30 8","pages":"e70413"},"PeriodicalIF":1.4,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13479935/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148764964","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":"Metabolic Syndrome and Cardiovascular Outcomes in Pediatric Kidney Transplant Recipients-A Cross-Sectional Study.","authors":"Anshuman Saha, Bhavik Champaneri, Vaidehi Patel, Harda Shah, Shahenaz Kapadia, Kinnari Vala, Disha Bhatt, Himanshu Patel, Dinesh Gera, Manisha Modi, Pranjal Modi","doi":"10.1111/petr.70438","DOIUrl":"10.1111/petr.70438","url":null,"abstract":"<p><strong>Background: </strong>The study aimed to determine the prevalence of obesity and metabolic syndrome (MS) and analyze the cardiovascular outcomes in pediatric kidney transplant recipients from a single center in India.</p><p><strong>Methods: </strong>Determinants of MS, including weight, height, body mass index (BMI), blood pressure, fasting blood sugar, triglyceride, and high-density lipoprotein (HDL) were collected for children with at least 1 year follow-up post-transplant. Cardiovascular outcomes were hypertension, left ventricular hypertrophy (LVH), and carotid intima medial thickness (cIMT). Muscle strength was evaluated by measuring hand grip strength (HGS). Diagnosis of obesity and MS was done by applying recommendations from the Pediatric Renal Nutrition Task Force.</p><p><strong>Results: </strong>The median age of the cohort (32 recipients, 71% male) was 14.0 years (IQR 12.0, 15.9). At a median 21.5 months (IQR 17, 37.5) after first kidney transplantation, 9 (28.1%) had MS. Hypertriglyceridemia was present in 17 children (53.1%), low HDL cholesterol in 10 (31.2%), hypertension in 22 (68.8%), and fasting hyperglycemia in 7 (21.9%). The ΔBMI height-age Z-score was significantly higher in the MS group (p = 0.003). There was no difference in eGFR, LVMI, Triglyceride index and HGS between the MS and Non-MS groups. In multivariate regression analysis, the ΔBMI height-age Z-score and Acute rejection were independent predictors of MS and LVH, respectively. MS was not an independent predictor of LVH. All patients had elevated cIMT.</p><p><strong>Conclusion: </strong>MS was found in about a third of the cohort. Graft function and LVH were similar between the groups. Post-transplant weight gain was a key determinant of MS.</p>","PeriodicalId":20038,"journal":{"name":"Pediatric Transplantation","volume":"30 8","pages":"e70438"},"PeriodicalIF":1.4,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13507869/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148819213","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":"Substance Use Patterns in Pediatric Solid Organ Transplant Candidates: Impact After Transplant.","authors":"Daniel Thomson, Anna Dammann, Eric Benz, Eliza Blanchette, Margret Bock, Elizabeth S Christofferson","doi":"10.1111/petr.70427","DOIUrl":"10.1111/petr.70427","url":null,"abstract":"<p><strong>Background: </strong>The prevalence and impact of substance use in pediatric solid organ transplant candidates and how these relate to post-transplant outcomes are not well studied.</p><p><strong>Methods: </strong>The Alcohol and Substance Use modules of the Kiddie Schedule for Affective Disorders and Schizophrenia (KSADS) were administered to all patients aged 12-18 who underwent heart, liver, or kidney transplant evaluation at our institution between 6/2020 and 12/2023. A total of 55 patients underwent KSADS testing at evaluation, received a transplant, and had adequate follow-up for inclusion. Following transplant, outcome measures included time-weighted coefficient of variance (TW-CoV) in serum tacrolimus level and organ rejection during follow-up.</p><p><strong>Results: </strong>A total of 9 patients (16%) endorsed ever trying any substance at time of pre-transplant evaluation. Past and present substance use impairment symptoms based on DSM-5 substance use impairment criteria pre-transplant were significantly associated with TW-CoV (past: r = 0.37, p = 0.006; present: r = 0.39, p = 0.003) in tacrolimus levels post-transplant. Past substance use impairment symptoms pre-transplant were associated with organ rejection by 1 year post-transplant (r = 0.32, p = 0.034). For patients who endorsed ever trying any substance, or trying any substance 5+ times, there were no significant differences for either group in adherence or rejection episodes when compared to patients who reported never trying any substance.</p><p><strong>Conclusion: </strong>Rates of substance use are relatively low in this population of pediatric solid organ transplant candidates. Substance use impairment symptoms identified pre-transplant are associated with increased rejection episodes and surrogate markers for non-adherence post-transplant.</p>","PeriodicalId":20038,"journal":{"name":"Pediatric Transplantation","volume":"30 8","pages":"e70427"},"PeriodicalIF":1.4,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13463279/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148713430","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":"Living Donor Liver Transplantation as Salvage Therapy for Steroid-Refractory Chronic Hepatic GVHD Following Allogeneic Hematopoietic Stem Cell Transplantation.","authors":"Urvi Kapoor, Steven J Lobritto, Monica Bhatia","doi":"10.1111/petr.70415","DOIUrl":"10.1111/petr.70415","url":null,"abstract":"<p><strong>Background: </strong>Hepatic graft-versus-host disease (GVHD) is a rare but life-threatening complication following allogeneic hematopoietic stem cell transplantation (HSCT). Steroid-refractory hepatic GVHD carries a high risk of mortality with limited salvage options. Liver transplantation after HSCT poses unique challenges due to dual alloimmunity and is rarely pursued, particularly in pediatric patients. We report a pediatric patient with steroid-refractory chronic hepatic GVHD successfully treated with living donor liver transplantation (LDLT) from a parental donor.</p><p><strong>Case presentation: </strong>A 13-year-old male underwent allogeneic HSCT for idiopathic severe aplastic anemia and developed progressive chronic hepatic GVHD characterized by ductopenia and severe cholestasis. His disease was refractory to corticosteroids and multiple additional therapies, including ruxolitinib, mesenchymal stromal cells, infliximab, sirolimus, anti-thymocyte globulin, alpha-1 antitrypsin, cyclophosphamide, and emapalumab. His course was complicated by Epstein-Barr virus (EBV) associated post-transplant lymphoproliferative disorder (PTLD), successfully treated with rituximab. Fifteen months after HSCT, and seven months after clearance of EBV viremia, he underwent LDLT from a parental donor. Donor selection preserved the option for future donor-derived EBV-specific cytotoxic T lymphocyte therapy if needed. Eleven months following LDLT, the patient remains clinically well, with normal liver function, sustained full donor chimerism, and no evidence of recurrent GVHD or PTLD.</p><p><strong>Conclusion: </strong>LDLT may represent a viable option in select pediatric patients with irreversible chronic hepatic GVHD. This case underscores the importance of early multidisciplinary planning and highlights the absence of liver-specific biomarkers or targeted therapies to guide management. Dedicated research into preventive and regenerative strategies is warranted.</p>","PeriodicalId":20038,"journal":{"name":"Pediatric Transplantation","volume":"30 8","pages":"e70415"},"PeriodicalIF":1.4,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13423123/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148631286","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}