{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,2]],"date-time":"2025-12-02T12:39:00Z","timestamp":1764679140509,"version":"3.46.0"},"reference-count":38,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2025,5,30]],"date-time":"2025-05-30T00:00:00Z","timestamp":1748563200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Transplantation"],"published-print":{"date-parts":[[2025,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Hematopoietic stem cell transplantation (HSCT) in solid organ transplant recipients has been reported in adults. However, data on children are scarce. We report a case of an allogeneic HSCT in a 14\u2010year\u2010old girl to treat idiopathic very severe aplastic anemia (SAA).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case Presentation<\/jats:title>\n                    <jats:p>The girl developed end\u2010stage renal disease at the age of 4\u2009years following Shiga toxin hemolytic\u2010uremic syndrome. The cadaveric kidney was grafted at the age of 7\u2009years. Three years later, the patient was successfully treated for active humoral graft rejection and continued with tacrolimus and antihypertensive treatment. At 10\u2009years, an absence epilepsy manifested; therefore, lamotrigine and ethosuximide were added. After 7\u2009years of having a kidney transplant, the patient developed very severe pancytopenia and was diagnosed with SAA. Parvovirus B19 and EBV infections were documented. At the age of 14\u2009years, she received allogeneic hematopoietic stem cells from a matched unrelated CMV\u2010seronegative donor. Neutrophils engrafted on Day +19 and full donor chimerism was achieved. An acute graft\u2010versus\u2010host disease grade II regressed after the escalation of immune suppression, which aggravated arterial hypertension and triggered CMV reactivation treated with glomerular filtration rate\u2010adjusted ganciclovir. Antiviral therapy deteriorated renal graft function. A high\u2010risk transplantation\u2010associated thrombotic microangiopathy was diagnosed on Day +42 and treated with eculizumab. Despite adoptive therapy with CMV\u2010specific cytotoxic T\u2010lymphocytes (Day +62) the pericardial effusion developed and required surgical drainage. Nevertheless, CMV viremia and polyserositis gradually progressed to multiorgan failure. The patient died on Day +95 after HSCT.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Despite reported favorable outcomes in children who received allogeneic HSCT after kidney transplantation, there is a lack of evidence on how to overcome numerous challenges in these ultrarare cases.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/petr.70108","type":"journal-article","created":{"date-parts":[[2025,5,30]],"date-time":"2025-05-30T13:33:42Z","timestamp":1748612022000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Case Report: Hematopoietic Stem Cell Transplantation to Treat Severe Acquired Aplastic Anemia in a Pediatric Kidney Transplant Recipient"],"prefix":"10.1111","volume":"29","author":[{"given":"Gintar\u0117","family":"Mierkien\u0117","sequence":"first","affiliation":[{"name":"Clinic 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