{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,3]],"date-time":"2026-10-03T09:52:24Z","timestamp":1791021144381,"version":"4.1.0"},"reference-count":25,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2026,10,3]],"date-time":"2026-10-03T00:00:00Z","timestamp":1790985600000},"content-version":"vor","delay-in-days":2,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"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":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>\n                      Guillain\u2010Barr\u00e9 syndrome (GBS) is an acute, immune\u2010mediated polyradiculoneuropathy most often triggered by infections such as\n                      <jats:styled-content style=\"fixed-case\">\n                        <jats:italic>Campylobacter jejuni<\/jats:italic>\n                      <\/jats:styled-content>\n                      , Epstein\u2013Barr virus (EBV), or cytomegalovirus (CMV). Although transplant\u2010associated GBS is recognized in adults, it remains rare in pediatric recipients, and distinguishing immune\u2010mediated disease from medication toxicity or critical illness can be challenging.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We describe two pediatric cases of GBS following organ transplantation, one after liver transplant and one after small bowel transplant. Clinical features, diagnostic evaluation, immunosuppression exposure, electrodiagnostic findings, imaging, and treatment outcomes were reviewed to characterize presentation patterns and diagnostic challenges.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The first patient developed rapidly progressive weakness shortly after liver transplantation in the setting of organ failure, adenovirus infection, and transient supratherapeutic tacrolimus levels. She demonstrated severe motor axonal involvement on nerve conduction studies and elevated neurofilament light chains, improving after intravenous immunoglobulin (IVIG). The second patient, years after small bowel transplantation complicated by chronic immune dysregulation and EBV viremia, presented with ascending weakness, areflexia, elevated CSF protein, and MRI enhancement of cauda equina and cranial nerves. Electrodiagnostics confirmed demyelinating polyneuropathy. Symptoms improved after IVIG despite concurrent tacrolimus level elevation. Across both cases, infectious triggers, immunosuppression, and critical illness obscured early recognition.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>GBS is an uncommon but important cause of acute weakness in pediatric transplant recipients. These cases show that GBS can occur both early and late after transplantation and may mimic medication toxicity or other complications. Early consideration of GBS, timely electrodiagnostic testing, and prompt immunotherapy are essential for optimizing outcomes in these patients.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/petr.70481","type":"journal-article","created":{"date-parts":[[2026,10,3]],"date-time":"2026-10-03T08:52:34Z","timestamp":1791017554000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Pediatric Guillain\u2010Barr\u00e9 Syndrome Post Organ Transplant: Acute and Chronic Complication Requiring High Index of Suspicion"],"prefix":"10.1111","volume":"30","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-7365-0147","authenticated-orcid":false,"given":"Liora","family":"Rabizadeh","sequence":"first","affiliation":[{"name":"Georgetown University School of Medicine  Washington DC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7503-2942","authenticated-orcid":false,"given":"Paola","family":"Pergami","sequence":"additional","affiliation":[{"name":"Pediatric Neurology, Department of Pediatrics Medstar Georgetown University Hospital  Washington DC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,3]]},"reference":[{"key":"e_1_2_9_2_1","volume-title":"StatPearls","author":"Nguyen T. P.","year":"2025"},{"key":"e_1_2_9_3_1","unstructured":"\u201cPediatric Guillain\u2010Barre Syndrome: Background Pathophysiology Etiology. eMedicine \u201d(2021) https:\/\/emedicine.medscape.com\/article\/1180594\u2010overview."},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.54380"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/ccr3.8184"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1155\/2014\/685010"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/cir074"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcv.2021.104844"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ensci.2016.08.001"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0210\u20105691(03)78912\u20101"},{"issue":"1","key":"e_1_2_9_11_1","doi-asserted-by":"crossref","DOI":"10.53855\/bjt.v27i1.609_ENG","article-title":"Guillain\u2010Barr\u00e9 Syndrome Secondary to Cytomegalovirus Infection in a Pediatric Kidney Transplant Patient","volume":"27","author":"Lopes D. S. G.","year":"2024","journal-title":"Brazilian Journal of Transplantation"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1155\/2012\/506290"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1038\/sj.bmt.1703412"},{"key":"e_1_2_9_14_1","doi-asserted-by":"crossref","DOI":"10.3389\/fped.2025.1610035","article-title":"Case Report: Post\u2010Surgical Guillain\u2010Barr\u00e9 Syndrome as a Rare Differential Diagnosis of Flaccid Paralysis of the Lower Extremities in an Infant After Cardiac Surgery","volume":"13","author":"Gross M.","year":"2025","journal-title":"Frontiers in Pediatrics"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2020.02017"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41582\u2010019\u20100250\u20109"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1358\/dnp.2003.16.5.829315"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1111\/ene.16365"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.3389\/fneur.2025.1572949"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.1212\/wnl.54.7.1453"},{"issue":"9","key":"e_1_2_9_21_1","doi-asserted-by":"crossref","DOI":"10.1111\/ctr.13512","article-title":"Cytomegalovirus in Solid Organ Transplant Recipients\u2014Guidelines of the American Society of Transplantation Infectious Diseases Community of Practice","volume":"33","author":"Razonable R. R.","year":"2019","journal-title":"Clinical Transplantation"},{"key":"e_1_2_9_22_1","doi-asserted-by":"publisher","DOI":"10.1111\/ctr.13652"},{"key":"e_1_2_9_23_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40264\u2010024\u201001398\u20105"},{"key":"e_1_2_9_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ebiom.2024.105072"},{"key":"e_1_2_9_25_1","unstructured":"National Institute of Neurological Disorders and Stroke \u201cGuillain\u2010Barr\u00e9 Syndrome NIH \u201d(2025) https:\/\/www.ninds.nih.gov\/health\u2010information\/disorders\/guillain\u2010barre\u2010syndrome."},{"key":"e_1_2_9_26_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12028\u2010019\u201000781\u2010"}],"container-title":["Pediatric Transplantation"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/petr.70481","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/petr.70481","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/petr.70481","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,3]],"date-time":"2026-10-03T08:52:41Z","timestamp":1791017561000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/petr.70481"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10]]},"references-count":25,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2026,10]]}},"alternative-id":["10.1111\/petr.70481"],"URL":"https:\/\/doi.org\/10.1111\/petr.70481","archive":["Portico"],"relation":{},"ISSN":["1397-3142","1399-3046"],"issn-type":[{"value":"1397-3142","type":"print"},{"value":"1399-3046","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10]]},"assertion":[{"value":"2026-02-24","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-25","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-10-03","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70481"}}