Pediatric Transplantation最新文献

{"title":"Donor-Derived Cell-Free DNA in Stable Pediatric Kidney Transplant Recipients: Influence of Donor Obesity and Recipient Size.","authors":"Julia Steinke, Lyndsay Harshman, Kelly Kirshner, Arundhati Kale, Erica Winnicki, Daniel Ranch, Jayanthi Chandar, Helen Pizzo, Arshdeep Kaur, Paul Hanson, Zunqiu Chen, Ling Shen, Dechu Puliyanda","doi":"10.1111/petr.70416","DOIUrl":"10.1111/petr.70416","url":null,"abstract":"<p><strong>Background: </strong>Donor-derived cell-free DNA (dd-cfDNA) is increasingly used as a noninvasive marker of kidney allograft injury, but adult-derived cutoffs may not be applicable to pediatric recipients, particularly in the setting of donor-recipient size mismatch. We evaluated dd-cfDNA levels in stable pediatric kidney transplant (KT) recipients and assessed variation by recipient weight and donor body mass index (BMI).</p><p><strong>Methods: </strong>Retrospective data were collected from seven U.S. pediatric KT centers. Clinically stable recipients < 18 years of age (no de novo donor specific antibody, biopsy-proven rejection or BK viremia/nephropathy), with ≥ 2 dd-cfDNA measurements per year were included. Recipients were stratified by weight at dd-cfDNA collection (< 20 kg, 20-50 kg, > 50 kg). Donor BMI was categorized as underweight (≤ 18.5), normal (18.6-24.9), overweight (25-29.9), or obese (≥ 30). Comparisons were performed using linear mixed-effects models.</p><p><strong>Results: </strong>Among 178 recipients, mean dd-cfDNA did not differ by recipient weight (< 20 kg: 0.51 ± 0.44; 20-50 kg: 0.65 ± 1.28; > 50 kg: 0.49 ± 0.70). Median dd-cfDNA was similar across donor BMI categories. However, among obese donors, recipients < 20 kg had 1.3-fold higher dd-cfDNA (p = 0.044). Donor-recipient body surface area mismatch > 1.5 was associated with 1.083-fold higher dd-cfDNA up to 5 years post-transplant (p = 0.016).</p><p><strong>Conclusions: </strong>In stable pediatric KT recipients, dd-cfDNA levels were well below the adult-derived 1% cutoff, reinforcing the generalizability of this cutoff to the pediatric population. Recipients < 20 kg with donor BMI > 30 kg/m² or in the setting of a donor-recipient BSA mismatch > 1.5 were associated with higher dd-cfDNA levels.</p>","PeriodicalId":20038,"journal":{"name":"Pediatric Transplantation","volume":"30 8","pages":"e70416"},"PeriodicalIF":1.4,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13479775/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148761210","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":"Combined Liver-Kidney Transplantation in Pediatric Patients From Colombia: A Case Series.","authors":"Alejandro Padilla-Guzmán, Sergio A Ortega-Gamboa, Jessica María Forero-Delgadillo, Vanessa Amparo Ochoa-Jiménez, Ana M Portilla-Buenaventura, Camilo José Cuadros Mateus, Verónica Botero-Osorio, Harry Pachajoa, Jaime M Restrepo","doi":"10.1111/petr.70419","DOIUrl":"10.1111/petr.70419","url":null,"abstract":"<p><strong>Background: </strong>Pediatric combined liver-kidney transplantation is uncommon, and evidence from Latin America is scarce.</p><p><strong>Methods: </strong>We report a single-center case series of four pediatric recipients who underwent combined liver-kidney transplantation at a tertiary Latin-American center. We summarize primary indications, perioperative course, early complications, and graft function at follow-up.</p><p><strong>Results: </strong>Underlying diseases were primary hyperoxaluria type I (n = 1), nephronophthisis type 3 (n = 2), and hepatorenal fibropolycystic disease/autosomal recessive polycystic kidney disease (n = 1). Early complications included bacterial and viral infections, bleeding, and acute tubular necrosis. Three biopsy-proven acute rejection episodes occurred (one moderate-severe hepatic and two renal, including one late T-cell-mediated episode); all responded to treatment. At last follow-up, all four patients were alive with functioning liver and kidney grafts. In three cases with long-term follow-up, the estimated glomerular filtration rate was 72, 64, and 48 mL/min/1.73 m² with normal liver profiles; in one case with shorter institutional follow-up, the estimated glomerular filtration rate was 74 mL/min/1.73 m² with a transient liver profile abnormality.</p><p><strong>Conclusions: </strong>This first pediatric series from Latin America suggests that combined liver-kidney transplantation is feasible and can achieve favorable long-term patient and graft survival when candidates are appropriately selected and infectious and rejection complications are managed in a protocolized manner.</p>","PeriodicalId":20038,"journal":{"name":"Pediatric Transplantation","volume":"30 8","pages":"e70419"},"PeriodicalIF":1.4,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13504720/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148813740","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":"Ultra-Low Weight < 5 Versus 5-9.9-kg Pediatric Liver Transplant Recipients: Characteristics and Intraoperative Vasopressor Comparisons.","authors":"Lori A Aronson, Kim My Li, Alexander J Bondoc, Stephen Hartman, Alyssa Stetson, Cheryl Hartzell, Nicolas Noriega, Lili Ding, Jiwon Lee","doi":"10.1111/petr.70420","DOIUrl":"10.1111/petr.70420","url":null,"abstract":"<p><strong>Background: </strong>Survival in pediatric liver transplantation (PLT) has significantly improved in infants under 1 year, but < 10 kg and < 6 months continue to have poor outcomes with a paucity of information on ultra-low weight (ULW) infants (< 5 kg). We compared intraoperative vasopressor use in < 5 kg versus 5-< 9.9 kg PLT recipients.</p><p><strong>Methods: </strong>We conducted a single-center retrospective review of all PLT recipients < 10 kg at time of transplant from 2009 to 2022, excluding multi-organ transplantation. We collected data on demographics, diagnosis, intraoperative vasoactive infusions, blood loss and requirements, and abdominal closure timing. Outcomes data include total mechanical ventilation, intensive care and hospital length of stay days, 1-year patient and graft survival and thrombotic complications.</p><p><strong>Results: </strong>ULW < 5 kg and 5-9.9 kg patients showed average weight of 4.53 versus 7.30 kg (p-value < 0.0001) and average age of transplant 3.36 versus 7.90 months (p-value 0.0002). The most common etiology of liver disease for ULW versus 5-9.9 kg was neonatal acute liver failure (3 of 5) versus biliary atresia (41 of 63). No significant difference in anhepatic time, abdominal closure, blood products transfused/kg, estimated blood loss/kg was noted. Total days of mechanical ventilation, ICU and hospital LOS were similar between groups. ULW trends toward higher doses of vasopressors during PLT, most notably at end of case compared to 5-9.9 kg (p = 0.06). Overall, 1-year graft and patient survival were 91% and 94%, respectively. HAT and PVT did not appear to be associated with VIS by phase of surgery, but PVT occurred relatively more in the < 5 kg group (2 vs. 4) and HAT in the 5-9.9 kg group (0 vs. 3).</p><p><strong>Conclusions: </strong>Results show etiology of liver failure differs and < 5 kg trends to an increased amount of vasopressor use, especially at end of case, suggesting more hemodynamic instability requiring support; however, this did not correlate with measured hospital metrics. Split graft PLT recipients have more blood loss and require more transfusions. PVT was observed more in the < 5 kg cohort. Etiology, not just size or early age, may contribute to the higher and sustained pressor requirements and possible PVT risk in ULW infants.</p>","PeriodicalId":20038,"journal":{"name":"Pediatric Transplantation","volume":"30 8","pages":"e70420"},"PeriodicalIF":1.4,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13444655/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148679528","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":"Survivorship Bias in the Shadows: A Methodological Concern Regarding Post-Transplant Survival Analysis in Pediatric VAD Recipients.","authors":"Saad Ishtiaq, Zain Mehboob Malik, Abdur Rahim Ahmad","doi":"10.1111/petr.70385","DOIUrl":"10.1111/petr.70385","url":null,"abstract":"","PeriodicalId":20038,"journal":{"name":"Pediatric Transplantation","volume":"30 8","pages":"e70385"},"PeriodicalIF":1.4,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13425747/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148631365","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":"TCR-αβ/CD 19 Depleted Graft Versus T Replete Graft With Post-Transplant Cyclophosphamide in Children Undergoing Haploidentical Donor Hematopoietic Stem Cell Transplantation for Inborn Errors of Immunity: A Comparative Analysis From India.","authors":"Anuraag Reddy Nalla, Kavitha Ganesan, Vijayshree Muthukumar, Minakshi Balwani, Nithya Seshadri, Krithika Krishnakumar, Ramya Uppuluri, Revathi Raj","doi":"10.1111/petr.70436","DOIUrl":"10.1111/petr.70436","url":null,"abstract":"<p><strong>Background: </strong>The study aimed to analyze the outcomes of TCRαβ/CD19-depleted and T-replete graft with post-transplant cyclophosphamide (PTCY) in haploidentical hematopoietic stem cell transplantation (HSCT) in inborn errors of immunity (IEI).</p><p><strong>Patients and methods: </strong>We performed a retrospective analysis of children from birth to 18 years of age with IEI who underwent haploidentical HSCT between April 2009 and September 2024, with a minimum follow-up period of 12 months.</p><p><strong>Results: </strong>A total of 230 children with IEI underwent HSCT in the 15-year period, where 105 (45%) underwent haploidentical HSCT and were included in the analysis with a follow up period of 0.5 to 170 months. TCR-αβ/CD19-depleted HSCT was done in 65 (62%) children, while T-replete graft with PTCY was used in 40 (38%) children. There was no significant difference in engraftment rates, acute and chronic graft versus host disease rates between both the cohorts: T-depleted group-89%, 8.6%, 12% respectively versus T-replete group-85%, 15%, 17.5% respectively. The 5-year overall survival was 62% (95% CI: 48%-73%) in the TCR-αβ/CD 19-depleted cohort in comparison to 54% (95% CI: 48% to 73%) in the PTCY cohort. When the survival was compared in children less than 2 years of age, it was 60% in the TCR-αβ/CD 19 depleted cohort versus 37% in PTCY cohort (p value of 0.001).</p><p><strong>Conclusion: </strong>Survival was superior in the T depleted cohort as compared to the T replete group, with viral reactivation remaining a persisting challenge. Letermovir prophylaxis and memory cell add-back would be potential strategies to improve survival.</p>","PeriodicalId":20038,"journal":{"name":"Pediatric Transplantation","volume":"30 8","pages":"e70436"},"PeriodicalIF":1.4,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13478695/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148759869","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":"The Hybrid Hub-and-Spoke Model: Revolutionizing Split Liver Transplantation Through Normothermic Machine Perfusion and AI-Driven Allocation.","authors":"Tran Cong Duy Long, Phan Minh Khoi, Nada Talaat Rahma, Dat Le Ba Ho, Quynh-Giao Nguyen, Nguyen Tien Huy","doi":"10.1111/petr.70428","DOIUrl":"10.1111/petr.70428","url":null,"abstract":"","PeriodicalId":20038,"journal":{"name":"Pediatric Transplantation","volume":"30 8","pages":"e70428"},"PeriodicalIF":1.4,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13479769/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148766360","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":"Response to: \"Optimizing Longitudinal Psychosocial Support in Pediatric Heart Transplant Recipients and Their Families\".","authors":"Leandra Bitterfeld, Kelly Mansfield, Lindsay J May","doi":"10.1111/petr.70435","DOIUrl":"https://doi.org/10.1111/petr.70435","url":null,"abstract":"","PeriodicalId":20038,"journal":{"name":"Pediatric Transplantation","volume":"30 8","pages":"e70435"},"PeriodicalIF":1.4,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13473886/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148761731","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":"Optimizing Longitudinal Psychosocial Support in Pediatric Heart Transplant Recipients and Their Families.","authors":"Teruhiko Imamura","doi":"10.1111/petr.70408","DOIUrl":"10.1111/petr.70408","url":null,"abstract":"","PeriodicalId":20038,"journal":{"name":"Pediatric Transplantation","volume":"30 8","pages":"e70408"},"PeriodicalIF":1.4,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13439327/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148674152","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":"Characterizing Early Donor-Derived cfDNA Kinetics in Stable Pediatric Living-Donor Liver Transplant Recipients.","authors":"Naresh Shanmugam, Avinash Ramani, Bhavani Gunasekaran, Pavan Kumar K Bapatla, Nivethitha Jayakanthan, Ebila Yesudhasan, Mohanty Rithika, Agragesh Ramani, Anu Vasudevan, V R Jagadeesh Menon, Ashwin Rammohan, Mohamed Rela","doi":"10.1111/petr.70410","DOIUrl":"10.1111/petr.70410","url":null,"abstract":"<p><strong>Background: </strong>Early and precise assessment of graft health is vital for pediatric liver transplant patients; however, current monitoring methods depend largely on invasive biopsies and non-specific biochemical tests. Donor-derived cell-free DNA (ddcfDNA) has emerged as a promising non-invasive biomarker for detecting graft injury, but data on its early post-transplant kinetics, baseline levels, and the influence of donor and recipient factors in stable pediatric populations remain limited.</p><p><strong>Objective: </strong>To prospectively characterize the early postoperative patterns of ddcfDNA and explore baseline ranges in clinically stable pediatric recipients of living donor liver transplants (LDLT), while evaluating the influence of recipient and donor demographic and clinical variables on ddcfDNA dynamics for improved non-invasive graft monitoring.</p><p><strong>Methods: </strong>In a cohort of 22 stable pediatric LDLT recipients, ddcfDNA levels were measured longitudinally using the Trunome GrafAssure assay at postoperative days 1-2, 7, 10-14, and 30-31. Concurrent liver function tests and clinical data were also collected. Statistical analyses were performed to evaluate correlations and determine the significance of the observed relationships.</p><p><strong>Results: </strong>ddcfDNA peaked on days 1-2 (~9.0%, 2.3 ng/mL), declined sharply by day 7 (~2.4%, 1.0 ng/mL), and stabilized by days 30-31 (~2.0%, 0.2 ng/mL). Liver enzymes decreased gradually. The absolute quantification values and the ddcfDNA percentage correlated with AST and ALT early post-transplant, with associations diminishing over time. Recipient and donor characteristics did not significantly affect ddcfDNA levels.</p><p><strong>Conclusion: </strong>dd-cfDNA demonstrates rapid postoperative clearance and stable longitudinal trends in clinically stable pediatric liver transplant recipients. The baseline values and kinetic patterns characterized provide a preliminary reference framework for future comparative studies evaluating dd-cfDNA behavior during graft dysfunction, rejection, or other adverse events in the early postoperative and surveillance periods.</p>","PeriodicalId":20038,"journal":{"name":"Pediatric Transplantation","volume":"30 8","pages":"e70410"},"PeriodicalIF":1.4,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13430581/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148664326","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":"Functional, Volumetric, and Growth Outcomes After Pediatric Bilateral Lung Transplantation.","authors":"Seon Yong Bae, Samina Park, Dae Hyeon Kim, Taeyoung Yun, Ji Hyeon Park, Bubse Na, Kwon Joong Na, Hyun Joo Lee, Ji Soo Park, Dong In Suh, Jimyung Park, In Kyu Park, Chang Hyun Kang, Young Tae Kim","doi":"10.1111/petr.70422","DOIUrl":"10.1111/petr.70422","url":null,"abstract":"<p><strong>Objective: </strong>Long-term multidimensional evaluations of pediatric lung transplantation are limited. This study assessed the functional recovery, volumetric adaptation, and growth in pediatric recipients by comparing age and graft type.</p><p><strong>Methods: </strong>This single-center, retrospective, descriptive study longitudinally reviewed 16 children (age < 18 years) who underwent bilateral deceased-donor lung transplantation. Perioperative characteristics, pulmonary function, computed tomography (CT)-derived lung volume, somatic growth, and survival were analyzed. Overall survival (OS) and chronic lung allograft dysfunction (CLAD)-free survival were estimated using the Kaplan-Meier method, and longitudinal physiological and developmental patterns were assessed descriptively.</p><p><strong>Results: </strong>In the younger group (≤ 10 years, n = 7) and the older group (> 10 years, n = 9), lobar transplantation was performed in 5 (71.4%) and 3 (33.3%) patients, respectively. CLAD was diagnosed in 1 younger recipient (14.3%) and 2 older recipients (22.2%). OS did not differ significantly between age groups (log-rank p = 0.96), and CLAD-free survival was comparable (log-rank p = 0.73). CT volumetry demonstrated progressive postoperative lung expansion with similar temporal trajectories across age groups and between lobar and whole-lung grafts. Growth patterns demonstrated meaningful postoperative improvement, with many children who exhibited faltering pretransplant growth demonstrating catch-up toward individualized percentile curves.</p><p><strong>Conclusions: </strong>Pediatric lung transplantation results in favorable long-term recovery, including functional improvement, durable volumetric adaptation, and partial restoration of growth dynamics. Comparable outcomes between lobar and whole-lung grafts support the use of size-reduced grafts in cases of donor-recipient mismatch.</p>","PeriodicalId":20038,"journal":{"name":"Pediatric Transplantation","volume":"30 8","pages":"e70422"},"PeriodicalIF":1.4,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13439153/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148674098","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}