{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,21]],"date-time":"2025-12-21T17:09:36Z","timestamp":1766336976922,"version":"3.48.0"},"reference-count":27,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2025,11,25]],"date-time":"2025-11-25T00:00:00Z","timestamp":1764028800000},"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":[[2025,12]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Hemophagocytic lymphohistiocytosis (HLH) is a rare complication of solid organ transplantation and is a syndrome of systemic hyperinflammation secondary to dysregulation of the inflammatory response, primarily involving lymphocytes and macrophages. It is often fatal and therefore early recognition and treatment are crucial. Among 11 adult cases of HLH in post\u2010lung transplant cases found in the literature, only one patient survived.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case<\/jats:title>\n                    <jats:p>We report the first known pediatric case of HLH following lung transplantation. The patient, a previously healthy adolescent, developed end\u2010stage bullous lung disease secondary to acute respiratory distress syndrome (ARDS) and underwent bilateral lung transplantation. Two months posttransplant, he was admitted with an asymptomatic febrile illness of unclear etiology. By day four, evolving multiorgan dysfunction raised concern for HLH. Despite extensive infectious, autoimmune, and malignancy workups, no definitive trigger was identified. Treatment was initiated with dexamethasone monotherapy with subsequent clinical improvement and discharge 1\u2009month later.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Solid organ transplantation appears to raise a patient's risk of developing HLH, although the underlying mechanisms are unclear. Literature review suggests patients are most likely to develop this complication within the first few months of transplantation, and a high index of suspicion must be maintained in those who present with a febrile illness of unclear etiology. Standard HLH treatment protocols may not be applicable to this patient population, and further studies are needed.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/petr.70232","type":"journal-article","created":{"date-parts":[[2025,11,26]],"date-time":"2025-11-26T07:27:33Z","timestamp":1764142053000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Hemophagocytic Lymphohistiocytosis in a Pediatric Lung Transplant Recipient"],"prefix":"10.1111","volume":"29","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5568-8952","authenticated-orcid":false,"given":"Sunil","family":"Chickmagalur","sequence":"first","affiliation":[{"name":"Division of Pulmonology, Department of Pediatrics Baylor College of Medicine  Houston Texas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6096-4889","authenticated-orcid":false,"given":"Anna","family":"Schrader","sequence":"additional","affiliation":[{"name":"Division of Pediatric Pulmonology, Department of Pediatrics Texas Children's Hospital  Houston Texas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dallas","family":"Parrish","sequence":"additional","affiliation":[{"name":"Division of Pediatric Pulmonology, Department of Pediatrics Texas Children's Hospital  Houston Texas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0049-1770","authenticated-orcid":false,"given":"David Moreno","family":"McNeill","sequence":"additional","affiliation":[{"name":"Division of Pulmonology, Department of Pediatrics Baylor College of Medicine  Houston Texas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7495-0311","authenticated-orcid":false,"given":"Maria C.","family":"Gazzaneo","sequence":"additional","affiliation":[{"name":"Division of Pulmonology, Department of Pediatrics Baylor College of Medicine  Houston Texas USA"},{"name":"Division of Critical Care, Department of Pediatrics Baylor College of Medicine  Houston Texas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5696-7112","authenticated-orcid":false,"given":"Ernestina","family":"Melicoff\u2010Portillo","sequence":"additional","affiliation":[{"name":"Division of Pulmonology, Department of Pediatrics Baylor College of Medicine  Houston Texas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1704-9284","authenticated-orcid":false,"given":"Nahir","family":"Cortes\u2010Santiago","sequence":"additional","affiliation":[{"name":"Department of Pathology &amp; Immunology Baylor College of Medicine  Houston Texas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,11,25]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.4187\/respcare.05304"},{"key":"e_1_2_7_3_1","first-page":"279","volume-title":"Psychosocial Care of End\u2010Stage Organ Disease and Transplant Patients","author":"Garrido G.","year":"2018"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1542\/pir.2021-004985"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/pbc.21039"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1096-911X(199705)28:5<342::AID-MPO3>3.0.CO;2-H"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.trim.2024.102007"},{"issue":"12","key":"e_1_2_7_8_1","article-title":"The Role of Immune Mechanisms, Inflammatory Pathways, and Macrophage Activation Syndrome in the Pathogenesis of Hemophagocytic Lymphohistiocytosis","volume":"14","author":"Bseiso O.","year":"2022","journal-title":"Cureus"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1093\/jpids\/piae007"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.eclinm.2023.102143"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1532\/IJH97.07012"},{"issue":"3","key":"e_1_2_7_12_1","first-page":"217","article-title":"Hemophagocytic Lymphohistiocytosis After Lung Transplant: Report of 2 Cases and a Literature Review","volume":"9","author":"Diaz\u2010Guzman E.","year":"2011","journal-title":"Experimental and Clinical Transplantation"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2010.05.021"},{"key":"e_1_2_7_14_1","article-title":"Post\u2010Acute Coronavirus Disease 2019 (COVID\u201019) Syndrome: HLH and Cholangiopathy in a Lung Transplant Recipient","volume":"15","author":"Roda S.","year":"2022","journal-title":"Clinical Infectious Diseases and Practice"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.healun.2021.01.2060"},{"issue":"4","key":"e_1_2_7_16_1","first-page":"A474","article-title":"A Case of Hemophagocytic Lymphohistiocytosis in a Post\u2010Double Lung Transplant Patient With COVID\u201019","volume":"160","author":"Ko J.","year":"2021","journal-title":"Chest"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.4266\/kjccm.2015.30.1.38"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.healun.2019.01.812"},{"issue":"8","key":"e_1_2_7_19_1","first-page":"1039","article-title":"Immunosuppression in Lung Transplantation","volume":"6","author":"Scheffert J. 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