{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,18]],"date-time":"2026-01-18T14:11:54Z","timestamp":1768745514383,"version":"3.49.0"},"reference-count":20,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2020,12,12]],"date-time":"2020-12-12T00:00:00Z","timestamp":1607731200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Transplantation"],"published-print":{"date-parts":[[2021,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Malignant hyperthermia (MH) is a rare life\u2010threatening anesthetic complication with high mortality rates. MH during adult kidney transplant has been reported previously. However, the occurrence of MH after multiple previous uneventful anesthetic exposures in a pediatric kidney transplant recipient is rare. To our knowledge, this is the first reported case of MH in a child undergoing a live donor kidney transplant. The approaches for addressing perioperative challenges and ethical dilemmas to ensure successful outcomes are described. The recipient, a 5\u2010year\u2010old male child, weighing 20\u00a0kg, with a history of multiple previous uneventful anesthetic exposures, underwent live donor kidney transplant for end\u2010stage renal disease (ESRD). Post\u2010reperfusion he developed fulminant MH with rapidly progressing hyperthermia, hypercarbia, tachycardia, and muscle rigidity, which in addition to complicating the medical management raised several ethical issues as well. MH was successfully managed with dantrolene and other supportive measures. Judicious use of inotropes and fluids helped maintain stable hemodynamics and graft perfusion. Management of MH is complicated in a pediatric patient with ESRD undergoing live donor kidney transplant. Preference for non\u2010depolarizing muscle relaxants instead of succinylcholine during endotracheal intubation can result in delayed onset of clinical manifestations. However, the metabolic complications may be more severe due to preexisting electrolyte and acid\u2010base disturbances. Maintaining optimal graft perfusion while simultaneously combating MH can be very challenging in a child. Since the allograft is a precious commodity, critical decisions regarding the harvesting of the donor kidney need to be well thought out. Early diagnosis and prompt treatment with dantrolene are critical to preserving graft function and the recipient's life.<\/jats:p>","DOI":"10.1111\/petr.13923","type":"journal-article","created":{"date-parts":[[2020,12,12]],"date-time":"2020-12-12T18:45:58Z","timestamp":1607798758000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Malignant hyperthermia during pediatric kidney transplantation\u2014A medical and ethical quandary"],"prefix":"10.1111","volume":"25","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9365-2125","authenticated-orcid":false,"given":"Sangeeth P.","family":"Srinivasan","sequence":"first","affiliation":[{"name":"Department of Anaesthesiology and Critical Care Aster Medcity Kochi India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nidhin","family":"Eldo","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology and Critical Care Aster Medcity Kochi 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