{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T18:19:50Z","timestamp":1787681990925,"version":"build-2784847793"},"reference-count":10,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T00:00:00Z","timestamp":1786579200000},"content-version":"vor","delay-in-days":12,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T00:00:00Z","timestamp":1785542400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Transplantation"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>\n                    Pediatric heart transplant (PHTR) recipients have reduced cardiorespiratory fitness (VO\n                    <jats:sub>2<\/jats:sub>\n                    peak); however, the magnitude of this impairment and its underlying central hemodynamic mechanisms remain poorly characterized. This systematic review and meta\u2010analysis quantified differences in VO\n                    <jats:sub>2<\/jats:sub>\n                    peak and peak exercise central hemodynamics between PHTR recipients and age\u2010matched healthy controls (CON). MEDLINE (PubMed) was searched for studies comparing VO\n                    <jats:sub>2<\/jats:sub>\n                    peak in PHTR recipients and CON. Pooled effect sizes were expressed as weighted mean differences (WMD) using a DerSimonian\u2013Laird random\u2010effects model, and weighted least\u2010squares meta\u2010regression assessed the moderating effects of age and time post\u2010transplant. Seven unique studies (PHTR\n                    <jats:italic>n<\/jats:italic>\n                    = 90; CON\n                    <jats:italic>n<\/jats:italic>\n                    = 118) reported VO\n                    <jats:sub>2<\/jats:sub>\n                    peak and peak HR. PHTR had significantly lower VO\n                    <jats:sub>2<\/jats:sub>\n                    peak (WMD\u00a0 = \u00a0\u22129.5\u00a0mL\/kg\/min), peak HR (WMD: \u221230\u00a0bpm), and CO (\n                    <jats:italic>n<\/jats:italic>\n                    = 3 studies, WMD: \u22122.5\u00a0L\/min), with no difference in peak SBP (\n                    <jats:italic>n<\/jats:italic>\n                    = 3 studies). Meta\u2010regression revealed no significant moderating effect of age or time post\u2010transplant on the VO\n                    <jats:sub>2<\/jats:sub>\n                    peak deficit. The markedly reduced VO\n                    <jats:sub>2<\/jats:sub>\n                    peak in PHTR recipients is driven primarily by impaired peak CO and persistent chronotropic incompetence, consistent with cardiac allograft sympathetic denervation.\n                  <\/jats:p>","DOI":"10.1111\/ctr.70646","type":"journal-article","created":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T15:37:06Z","timestamp":1786635426000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Meta\u2010Analysis of Cardiorespiratory Fitness Impairment in Pediatric Heart Transplant Recipients"],"prefix":"10.1111","volume":"40","author":[{"given":"Nadeen","family":"Wu","sequence":"first","affiliation":[{"name":"Integrated Cardiovascular Exercise Physiology and Rehabilitation Laboratory Faculty of Nursing College of Health Sciences University of Alberta  Edmonton Alberta Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen J.","family":"Foulkes","sequence":"additional","affiliation":[{"name":"Integrated Cardiovascular Exercise Physiology and Rehabilitation Laboratory Faculty of Nursing College of Health Sciences University of Alberta  Edmonton Alberta Canada"},{"name":"Heart, Exercise and Research Trials Lab St Vincent's Institute of Medical Research Fitzroy Victoria Australia"},{"name":"Baker Department of Cardiometabolic Health University of Melbourne  Parkville Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nathan R.","family":"Weeldreyer","sequence":"additional","affiliation":[{"name":"Integrated Cardiovascular Exercise Physiology and Rehabilitation Laboratory Faculty of Nursing College of Health Sciences University of Alberta  Edmonton Alberta Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Calvin","family":"Kruger","sequence":"additional","affiliation":[{"name":"Integrated Cardiovascular Exercise Physiology and Rehabilitation Laboratory Faculty of Nursing College of Health Sciences University of Alberta  Edmonton Alberta Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Corey R.","family":"Tomczak","sequence":"additional","affiliation":[{"name":"College of Kinesiology University of Saskatchewan  Saskatoon Saskatchewan Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Khoury","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Faculty of Medicine and Dentistry College of Health Sciences University of Alberta  Edmonton Alberta Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer L.","family":"Conway","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Faculty of Medicine and Dentistry College of Health Sciences University of Alberta  Edmonton Alberta Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark J.","family":"Haykowsky","sequence":"additional","affiliation":[{"name":"Integrated Cardiovascular Exercise Physiology and Rehabilitation Laboratory Faculty of Nursing College of Health Sciences University of Alberta  Edmonton Alberta Canada"},{"name":"Hochgebirgsklinik Davos Medicine Campus Davos  Davos Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,13]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.healun.2025.10.022"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-6143.2012.04046.x"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/petr.12922"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-3476(05)81213-2"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1378\/chest.107.5.1328"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1034\/j.1399-3046.2001.t01-2-00032.x"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00424-001-0755-z"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.healun.2003.09.019"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.healun.2012.09.029"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.1249\/MSS.0000000000001889"}],"container-title":["Clinical Transplantation"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/ctr.70646","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/ctr.70646","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/ctr.70646","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T17:31:30Z","timestamp":1787679090000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/ctr.70646"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8]]},"references-count":10,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2026,8]]}},"alternative-id":["10.1111\/ctr.70646"],"URL":"https:\/\/doi.org\/10.1111\/ctr.70646","archive":["Portico"],"relation":{},"ISSN":["0902-0063","1399-0012"],"issn-type":[{"value":"0902-0063","type":"print"},{"value":"1399-0012","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8]]},"assertion":[{"value":"2026-06-16","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication 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