{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T01:39:55Z","timestamp":1789609195655,"version":"build-2803163510"},"reference-count":15,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2013,6,3]],"date-time":"2013-06-03T00:00:00Z","timestamp":1370217600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pediatric Transplantation"],"published-print":{"date-parts":[[2013,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>AIHA is a rare and serious complication of solid organ transplantation. Herein, we report four cases of warm or mixed <jats:styled-content style=\"fixed-case\">AIHA<\/jats:styled-content> in pediatric patients following combined liver, small bowel and pancreas transplant. The hemolysis was refractory to multiple treatment modalities including steroids, rituximab, IVIG, plasmapheresis, cytoxan, discontinuation of prophylactic penicillin, and a change in immunosuppression from tacrolimus to cyclosporine. All patients had resolution or marked improvement of hemolysis after discontinuation of maintenance of <jats:styled-content style=\"fixed-case\">CNI<\/jats:styled-content> and initiation of sirolimus immunosuppression. One patient developed nephrotic syndrome but responded to a change in immunosuppression to everolimus. Three of the four patients continue on immunosuppression with sirolimus or everolimus without further hemolysis, evidence of rejection or medication side effects. Based on our experience and review of similar cases in the literature, we have proposed a treatment algorithm for <jats:styled-content style=\"fixed-case\">AIHA<\/jats:styled-content> in the pediatric intestinal transplant patient population that recommends an early change in immunosuppressive regimen from <jats:styled-content style=\"fixed-case\">CNI<\/jats:styled-content>s to sirolimus therapy.<\/jats:p>","DOI":"10.1111\/petr.12101","type":"journal-article","created":{"date-parts":[[2013,6,3]],"date-time":"2013-06-03T12:28:37Z","timestamp":1370262517000},"page":"466-471","source":"Crossref","is-referenced-by-count":34,"title":["Refractory autoimmune hemolytic anemia after intestinal transplant responding to conversion from a calcineurin to <scp>mTOR<\/scp> inhibitor"],"prefix":"10.1111","volume":"17","author":[{"given":"Melissa A.","family":"Acquazzino","sequence":"first","affiliation":[{"name":"Department of Pediatrics University of Nebraska Medical Center Omaha NE USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryan T.","family":"Fischer","sequence":"additional","affiliation":[{"name":"Department of Pediatric Gastroenterology and Hepatology Children's Mercy Hospital and Clinics Kansas City MO USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alan","family":"Langnas","sequence":"additional","affiliation":[{"name":"Department of Transplant Surgery University of Nebraska Medical Center Omaha NE USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Don W.","family":"Coulter","sequence":"additional","affiliation":[{"name":"Department of Pediatric Hematology and Oncology University of Nebraska Medical Center Omaha NE USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2013,6,3]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1537-2995.1998.38398222864.x"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/ajh.10062"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1537-2995.2002.00026.x"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1432-2277.2010.01091.x"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1432-2277.2007.00619.x"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1399-3046.2008.00934.x"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1399-3046.2005.00460.x"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1399-3046.2007.00795.x"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1399-3046.2010.01363.x"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1002\/pbc.22183"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0b013e3181485124"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1399-3046.2007.00832.x"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1399-3046.2011.01477.x"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00423-007-0174-5"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1159\/000327972"}],"container-title":["Pediatric Transplantation"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Fpetr.12101","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/petr.12101","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,10,1]],"date-time":"2023-10-01T22:39:52Z","timestamp":1696199992000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/petr.12101"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2013,6,3]]},"references-count":15,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2013,8]]}},"alternative-id":["10.1111\/petr.12101"],"URL":"https:\/\/doi.org\/10.1111\/petr.12101","archive":["Portico"],"relation":{},"ISSN":["1397-3142","1399-3046"],"issn-type":[{"value":"1397-3142","type":"print"},{"value":"1399-3046","type":"electronic"}],"subject":[],"published":{"date-parts":[[2013,6,3]]}}}