{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,2]],"date-time":"2025-12-02T12:38:37Z","timestamp":1764679117618,"version":"3.46.0"},"reference-count":11,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2025,8,5]],"date-time":"2025-08-05T00:00:00Z","timestamp":1754352000000},"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":"ABSTRACT<\/jats:title>\n \n Background<\/jats:title>\n Although dual\u2010drug immunosuppression is standard for rejection prophylaxis in pediatric heart transplant (HT), single\u2010drug immunosuppression (monotherapy) may be appropriate for certain patients. We describe the experience with monotherapy in select patients at a single institution.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n Retrospective review of HT patients at a pediatric transplant center who underwent HT between 1\/2001\u201312\/2020 and were treated with calcineurin\u2010inhibitor monotherapy for >\u20091\u2009month. Patients were transitioned to monotherapy due to concerns for over\u2010immune suppression, including recurrent infection, neutropenia, or post\u2010transplant lymphoproliferative disorder (PTLD). Clinical characteristics and patient outcomes were analyzed.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n During the study period, 16\/318 (5%) HT patients were placed on monotherapy at a median of 4.6\u2009years post\u2010HT (IQR 1.8\u20136.9\u2009years). Most patients on monotherapy were transplanted as infants (81%, 13\/16), 56% (9\/16) were male, and 50% (8\/16) underwent HT for congenital heart disease (CHD). Most (81%) were on tacrolimus monotherapy. The indication for monotherapy was recurrent infection in 50%, PTLD in 31%, and neutropenia in 19%. At a median follow\u2010up of 1.5\u2009years (IQR 1.1\u20132.2\u2009years), there were no episodes of moderate or greater rejection and no evidence of coronary allograft vasculopathy. At last follow\u2010up, 87% of patients remain on monotherapy, and 94% of patients are alive and well, including one patient who has continued monotherapy for over 15\u2009years.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Monotherapy immunosuppression with calcineurin inhibitors may be preferred in a subset of pediatric HT patients with evidence of over\u2010immune suppression without conferring increased risk of rejection.<\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/petr.70157","type":"journal-article","created":{"date-parts":[[2025,8,5]],"date-time":"2025-08-05T11:14:52Z","timestamp":1754392492000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Monotherapy Immunosuppression in Pediatric Heart Transplant Recipients"],"prefix":"10.1111","volume":"29","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1578-3346","authenticated-orcid":false,"given":"Elizabeth L.","family":"Profita","sequence":"first","affiliation":[{"name":"Department of Pediatrics (Cardiology) Stanford University Palo Alto California USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8008-6910","authenticated-orcid":false,"given":"Joanne","family":"Lee","sequence":"additional","affiliation":[{"name":"Pediatric Solid Organ Transplant Center Lucile Packard Children's Hospital Stanford Palo Alto California USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Donna","family":"Lee","sequence":"additional","affiliation":[{"name":"Pediatric Solid Organ Transplant Center Lucile Packard Children's Hospital Stanford Palo Alto California USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lynsey","family":"Barkoff","sequence":"additional","affiliation":[{"name":"Pediatric Solid Organ Transplant Center Lucile Packard Children's Hospital Stanford Palo Alto California USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-1950-6550","authenticated-orcid":false,"given":"Kari","family":"Wujcik","sequence":"additional","affiliation":[{"name":"Pediatric Solid Organ Transplant Center Lucile Packard Children's Hospital Stanford Palo Alto California USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1636-9633","authenticated-orcid":false,"given":"Chiu\u2010Yu","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Pediatrics (Cardiology) Stanford University Palo Alto California USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel","family":"Bernstein","sequence":"additional","affiliation":[{"name":"Department of Pediatrics (Cardiology) Stanford University Palo Alto California USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0818-3150","authenticated-orcid":false,"given":"Seth A.","family":"Hollander","sequence":"additional","affiliation":[{"name":"Department of Pediatrics (Cardiology) Stanford University Palo Alto California USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,8,5]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/J.HEALUN.2022.10.015"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1007\/S11936\u2010010\u20100085\u20106\/METRICS"},{"issue":"6","key":"e_1_2_9_4_1","first-page":"281","article-title":"Immunosuppressive Drugs After Solid Organ Transplantation","volume":"71","author":"Sandwijk M. S.","year":"2013","journal-title":"Netherlands Journal of Medicine"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCHEARTFAILURE.110.958520"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.healun.2006.02.003"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/J.HEALUN.2023.02.1705"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40472\u2010015\u20100081\u20106"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/J.HEALUN.2019.08.002"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/J.HEALUN.2022.07.019"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbi.2008.08.010"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbi.2019.103208"}],"container-title":["Pediatric Transplantation"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/petr.70157","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,2]],"date-time":"2025-12-02T12:35:36Z","timestamp":1764678936000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/petr.70157"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,5]]},"references-count":11,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2025,9]]}},"alternative-id":["10.1111\/petr.70157"],"URL":"https:\/\/doi.org\/10.1111\/petr.70157","archive":["Portico"],"relation":{},"ISSN":["1397-3142","1399-3046"],"issn-type":[{"type":"print","value":"1397-3142"},{"type":"electronic","value":"1399-3046"}],"subject":[],"published":{"date-parts":[[2025,8,5]]},"assertion":[{"value":"2025-03-12","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-07-29","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-08-05","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70157"}}