{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,10]],"date-time":"2026-01-10T03:42:33Z","timestamp":1768016553912,"version":"3.49.0"},"reference-count":12,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2023,1,30]],"date-time":"2023-01-30T00:00:00Z","timestamp":1675036800000},"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":[[2023,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Locked\u2010in syndrome represents the most severe form of central pontine myelinolysis and varies in presentation from asymptomatic to fully developed locked\u2010in\u2010syndrome characterized by the combination of quadriplegia, loss of the ability to communicate except through the use of the eyes, and an inability to follow commands.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We report a 10\u2010year\u2010old boy who developed a severe case of locked\u2010in syndrome after heart transplantation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Patient had a spontaneous recovery, treated with supportive treatment and the improvement was detected with cessation of calcineurin inhibitor therapy by substituting with an mTOR inhibitor (sirolimus). No cases of locked\u2010in syndrome post\u2010heart transplant in pediatrics cases have been documented in the literature.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Physicians should recognize a rapid progression of central pontine myelinolysis and locked\u2010in syndrome in the context of heart transplant and although several factors likely contributed to this outcome, adjustment of immunosuppression including by substituting tacrolimus with sirolimus could be effective.<\/jats:p><\/jats:sec>","DOI":"10.1111\/petr.14474","type":"journal-article","created":{"date-parts":[[2023,1,31]],"date-time":"2023-01-31T04:58:47Z","timestamp":1675141127000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Central pontine myelinolysis and locked\u2010IN syndrome associated with tacrolimus after pediatric heart transplantation"],"prefix":"10.1111","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5101-6905","authenticated-orcid":false,"given":"Dimpna C.","family":"Albert\u2010Brotons","sequence":"first","affiliation":[{"name":"King Faisal Specialist Hospital &amp; 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