{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T08:58:48Z","timestamp":1790413128500,"version":"4.1.0"},"reference-count":24,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T00:00:00Z","timestamp":1783987200000},"content-version":"vor","delay-in-days":13,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Transplantation"],"published-print":{"date-parts":[[2026,7]]},"abstract":"ABSTRACT<\/jats:title>\n \n Introduction<\/jats:title>\n Liver transplantation is the standard treatment for pediatric patients with cirrhosis, acute liver failure, metabolic liver disease, and malignancy. Plasma cell\u2010rich rejection is a poorly characterized form of late\u2010onset rejection. We aimed to evaluate the incidence and clinicopathological factors associated with plasma cell\u2010rich rejection in pediatric liver transplant recipients in Johannesburg, South Africa.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n We conducted a retrospective review of 91 pediatric liver transplant recipients (\u2264\u200918\u2009years) who underwent transplantation between January 1, 2015, and December 31, 2021. Demographics, clinical characteristics, episodes of acute cellular rejection, Banff Rejection Activity Index scores, histopathological findings, medication level variability index, and outcomes were analyzed. Survival outcomes were assessed using the Kaplan\u2013Meier methods and Cox proportional hazards models, with follow\u2010up censored as of 31 December 2023.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Of 91 recipients, 45 (49.5%) developed acute cellular rejection, with a median medication level variability index of 2.05 (1.1\u20133.3). Late\u2010onset acute cellular rejection occurred in 19 of these 45 patients (42.2%). Plasma cell\u2010rich rejection was identified in 14 patients (15.3%) and was associated with increased frequency and severity of acute cellular rejection episodes (\n p<\/jats:italic>\n \u2009<\u20090.001), autoimmune seropositivity (\n p<\/jats:italic>\n \u2009=\u20090.008), central perivenulitis (\n p<\/jats:italic>\n \u2009<\u20090.001), and chronic rejection (\n p<\/jats:italic>\n \u2009=\u20090.006). In multivariable logistic regression, recurrent rejection episodes (OR 22.04, 95% CI 5.08\u201395.52;\n p<\/jats:italic>\n \u2009<\u20090.001) and severe rejection (OR 3.60, 95% CI 1.66\u20137.78;\n p<\/jats:italic>\n \u2009=\u20090.001) were independently associated with PCRR. Plasma cell\u2010rich rejection was not independently associated with mortality in a Cox proportional hazards analysis (HR 0.51, 95% CI 0.15\u20131.73;\n p<\/jats:italic>\n \u2009=\u20090.282). Mortality was independently associated with higher medication level variability index values (HR 1.06, 95% CI 1.03\u20131.09;\n p<\/jats:italic>\n \u2009<\u20090.001), severe rejection Banff Rejection Activity Index score 7\u20139 (HR 1.42, 95% CI 1.00\u20131.99;\n p<\/jats:italic>\n \u2009=\u20090.049), and cytomegalovirus disease (HR 3.71, 95% CI 1.67\u20138.25;\n p<\/jats:italic>\n \u2009=\u20090.001).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n Plasma cell\u2010rich rejection is associated with frequent and severe rejection episodes, autoimmune markers, central perivenulitis, and chronic rejection. PCRR was not independently associated with mortality; mortality was associated with higher medication level variability index values, severe rejection, and CMV disease. Early recognition of these clinicopathological associations may support closer monitoring and inform future research into targeted management strategies.<\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/petr.70403","type":"journal-article","created":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T09:28:22Z","timestamp":1784021302000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Clinicopathological Associations of Plasma Cell\u2010Rich Rejection in Pediatric Liver Transplant Recipients"],"prefix":"10.1111","volume":"30","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5521-2268","authenticated-orcid":false,"given":"R.","family":"Gemell","sequence":"first","affiliation":[{"name":"Department of Paediatrics and Child Health University of Witwatersrand, Faculty of Health Sciences Johannesburg South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C.","family":"Hajinicolaou","sequence":"additional","affiliation":[{"name":"Department of Paediatrics and Child Health University of Witwatersrand, Faculty of Health Sciences Johannesburg South Africa"},{"name":"Division of Paediatric Gastroenterology, Department of Paediatrics and Child Health, Hepatology and Nutrition Chris Hani Baragwanath Academic Hospital Johannesburg South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"Hale","sequence":"additional","affiliation":[{"name":"Department of Anatomical Pathology, School of Pathology, Faculty of Health Sciences University of the Witwatersrand Johannesburg South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P.","family":"Walabh","sequence":"additional","affiliation":[{"name":"Department of Paediatrics and Child Health University of Witwatersrand, Faculty of Health Sciences Johannesburg South Africa"},{"name":"Division of Paediatric Gastroenterology\/Hepatology and Nutrition, Department of Paediatrics and Child Health Charlotte Maxeke Johannesburg Academic Hospital Johannesburg South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,7,14]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"publisher","DOI":"10.18772\/26180197.2019.v1n3a1"},{"key":"e_1_2_13_3_1","doi-asserted-by":"publisher","DOI":"10.1155\/2023\/3103335"},{"key":"e_1_2_13_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/9781119634010.ch36"},{"key":"e_1_2_13_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2021.07.027"},{"key":"e_1_2_13_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/ajt.13909"},{"key":"e_1_2_13_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/ajt.12413"},{"key":"e_1_2_13_8_1","doi-asserted-by":"publisher","DOI":"10.1093\/ajcp\/aqad004"},{"key":"e_1_2_13_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.liver.2022.100108"},{"key":"e_1_2_13_10_1","doi-asserted-by":"publisher","DOI":"10.1097\/TP.0000000000002147"},{"key":"e_1_2_13_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/ajt.14276"},{"key":"e_1_2_13_12_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40272\u2010013\u20100034\u20104"},{"key":"e_1_2_13_13_1","first-page":"960","article-title":"Liver Transplantation at Red Cross War Memorial Children's Hospital","volume":"96","author":"Spearman C. 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