{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,12]],"date-time":"2025-11-12T09:40:39Z","timestamp":1762940439528,"version":"3.45.0"},"reference-count":29,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2025,10,22]],"date-time":"2025-10-22T00:00:00Z","timestamp":1761091200000},"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":[[2025,11]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Pediatric acute liver failure represents a significant health care concern with significant morbidity and mortality. High\u2010volume plasma exchange has been shown to serve as an effective blood purification technique that has allowed patients with ALF to survive to liver transplantation, or in some cases even spontaneous recovery. This study describes a novel anticoagulation protocol using a combination of citrate and heparin for high\u2010volume plasma exchange in pediatric acute liver failure patients and demonstrates the safety of high\u2010volume plasma exchange in pediatric acute liver failure patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This study retrospectively reviews a series of patients younger than 18\u2009years of age with acute liver failure, analyzing the safety of high\u2010volume plasma exchange in a single\u2010center tertiary pediatric intensive care unit.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Twelve encounters with 11 unique patients were included. Switching anticoagulation from citrate only to citrate plus heparin decreased the incidence of citrate lock from 80% to 25% (odds ratio 0.083), with no bleeding complications. No patients experienced life\u2010threatening adverse events. Non\u2010severe adverse events occurred in 29 of 66 treatments (44%), including citrate lock (19 of 66 treatments), responsive hypotension (8\/66 high\u2010volume plasma exchange treatments), and transient hypothermia (3\/66 HVPE treatments).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>High\u2010volume plasma exchange is well tolerated in pediatric acute liver failure and can safely be used as a bridge to liver transplantation or spontaneous recovery. Adding heparin to a citrate anticoagulation strategy during high\u2010volume plasma exchange can decrease the frequency of citrate lock without increasing the risk of bleeding.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/petr.70213","type":"journal-article","created":{"date-parts":[[2025,10,22]],"date-time":"2025-10-22T08:05:11Z","timestamp":1761120311000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["A Novel Anticoagulation Strategy for High\u2010Volume Plasma Exchange in Pediatric Patients With Acute Liver Failure"],"prefix":"10.1111","volume":"29","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-7529-8482","authenticated-orcid":false,"given":"Amanda M.","family":"Walker","sequence":"first","affiliation":[{"name":"Division of Pediatric Critical Care Nemours Children's Hospital, Delaware  Wilmington Delaware USA"},{"name":"Department of Pediatrics Sidney Kimmel Medical College, Thomas Jefferson University  Philadelphia Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5678-2000","authenticated-orcid":false,"given":"Kevin D.","family":"Smith","sequence":"additional","affiliation":[{"name":"Department of Pediatrics University of Chicago Medicine  Chicago Illinois USA"},{"name":"Section of Pediatric Critical Care, Department of Pediatrics University of Chicago  Chicago Illinois USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-3429-0808","authenticated-orcid":false,"given":"Joella L.","family":"Slowik","sequence":"additional","affiliation":[{"name":"Division of Pediatric Critical Care Nemours Children's Hospital, Delaware  Wilmington Delaware USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-5184-3335","authenticated-orcid":false,"given":"Anna","family":"McCudden","sequence":"additional","affiliation":[{"name":"Division of Pediatric Critical Care Nemours Children's Hospital, Delaware  Wilmington Delaware USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2609-6605","authenticated-orcid":false,"given":"Md. 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