{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,2]],"date-time":"2025-12-02T12:38:51Z","timestamp":1764679131422,"version":"3.46.0"},"reference-count":24,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2025,8,10]],"date-time":"2025-08-10T00:00:00Z","timestamp":1754784000000},"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":[[2025,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Intravenous corticosteroids and anti\u2010thymocyte globulin (ATG) are standard treatment agents for acute T\u2010cell mediated rejection (TCMR). Little data exist on the role of second\u2010line treatment agents for TCMR when refractory to standard agents. Local graft irradiation (LGI) was historically used but there are few reports of its use in the modern era.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Five patients underwent a LGI protocol (150\u2009cGy \u00d7\u20093 doses) for biopsy\u2010proven TCMR that was persistent after treatment with maximally tolerated standard agents. Outcomes included post\u2010LGI biopsy findings, serum creatinine (SCr) at 1\u2009week, 1\u2009month, and 12\u2009months after LGI &amp; graft survival and subsequent rejection episodes at last evaluation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In three of five cases, active TCMR resolved on post\u2010LGI biopsy. One patient did not undergo post\u2010LGI biopsy, and one patient had persistent TCMR requiring further salvage therapy. Four patients had ongoing graft survival with no further episodes of acute TCMR at last evaluation (6\u2013119\u2009months). One patient had graft loss requiring return to dialysis at 5\u2009months post\u2010LGI. One patient had acute endothelial injury on post\u2010LGI biopsy associated with a rise in SCr at 1 week and 1 month post\u2010LGI. All other patients had no change or improvement in serum creatinine at these time points.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>LGI may be a viable salvage therapy in pediatric and young adult patients experiencing TCMR refractory to traditional treatments. We suggest further studies to fully assess the efficacy and risk of this therapy in clinical practice.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/petr.70132","type":"journal-article","created":{"date-parts":[[2025,8,11]],"date-time":"2025-08-11T03:49:41Z","timestamp":1754884181000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Local Graft Irradiation to Treat Refractory Acute Rejection in Pediatric and Young Adult Kidney Transplant Patients: A Case Series and Review of the Literature"],"prefix":"10.1111","volume":"29","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-8883-7776","authenticated-orcid":false,"given":"Corinne M.","family":"Hite","sequence":"first","affiliation":[{"name":"Division of Nephrology &amp; Hypertension, Department of Pediatrics Cincinnati Children's Hospital Medical Center  Cincinnati Ohio USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0409-3799","authenticated-orcid":false,"given":"Charles D.","family":"Varnell","sequence":"additional","affiliation":[{"name":"Division of Nephrology &amp; Hypertension, Department of Pediatrics Cincinnati Children's Hospital Medical Center  Cincinnati Ohio USA"},{"name":"James M. Anderson Center for Health Systems Excellence Cincinnati Children's Hospital Medical Center  Cincinnati Ohio USA"},{"name":"University of Cincinnati School of Medicine  Cincinnati Ohio USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-2010-4327","authenticated-orcid":false,"given":"Katherine A.","family":"VandenHeuvel","sequence":"additional","affiliation":[{"name":"University of Cincinnati School of Medicine  Cincinnati Ohio USA"},{"name":"Division of Pathology and Laboratory Medicine, Department of Pediatrics Cincinnati Children's Hospital Medical Center  Cincinnati Ohio USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-2096-4945","authenticated-orcid":false,"given":"E. Steve","family":"Woodle","sequence":"additional","affiliation":[{"name":"Division of Transplantation, Department of Surgery University of Cincinnati Medical Center  Cincinnati Ohio USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"William L.","family":"Barrett","sequence":"additional","affiliation":[{"name":"Division of Radiation Oncology University of Cincinnati Medical Center  Cincinnati Ohio USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8732-4291","authenticated-orcid":false,"given":"David K.","family":"Hooper","sequence":"additional","affiliation":[{"name":"Division of Nephrology &amp; Hypertension, Department of Pediatrics Cincinnati Children's Hospital Medical Center  Cincinnati Ohio USA"},{"name":"James M. Anderson Center for Health Systems Excellence Cincinnati Children's Hospital Medical Center  Cincinnati Ohio USA"},{"name":"University of Cincinnati School of Medicine  Cincinnati Ohio USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,8,10]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/petr.13597"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1034\/j.1399\u20103046.2000.00096.x"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/tp.0000000000002366"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm12154927"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1177\/2054358117753616"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/petr.13334"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/ajt.16907"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/petr.14617"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1159\/000351643"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0170259"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1097\/TP.0b013e31819d3353"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1097\/00007890\u2010199609150\u201000009"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1097\/00007890\u2010199403270\u201000016"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/0360\u20103016(95)02159\u20100"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/s0360\u20103016(99)00474\u20105"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.coc.0000231452.47998.88"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.radonc.2004.08.011"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.5812\/numonthly.16262"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/s0360\u20103016(96)00340\u20109"},{"key":"e_1_2_9_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.kint.2020.07.025"},{"key":"e_1_2_9_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/0360\u20103016(82)90084\u20100"},{"key":"e_1_2_9_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140\u20106736(76)92715\u2010X"},{"key":"e_1_2_9_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/0360\u20103016(90)90437\u2010o"},{"key":"e_1_2_9_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/0360\u20103016(84)90168\u20108"}],"container-title":["Pediatric Transplantation"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/petr.70132","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,2]],"date-time":"2025-12-02T12:35:32Z","timestamp":1764678932000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/petr.70132"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,10]]},"references-count":24,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2025,9]]}},"alternative-id":["10.1111\/petr.70132"],"URL":"https:\/\/doi.org\/10.1111\/petr.70132","archive":["Portico"],"relation":{},"ISSN":["1397-3142","1399-3046"],"issn-type":[{"type":"print","value":"1397-3142"},{"type":"electronic","value":"1399-3046"}],"subject":[],"published":{"date-parts":[[2025,8,10]]},"assertion":[{"value":"2025-03-20","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-06-30","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-08-10","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70132"}}