{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T05:46:02Z","timestamp":1791783962217,"version":"4.3.4"},"reference-count":12,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2026,10,11]],"date-time":"2026-10-11T00:00:00Z","timestamp":1791676800000},"content-version":"vor","delay-in-days":10,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"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>Ascending cholangitis, one of the most common complications in patients with biliary atresia (BA) after Kasai hepatoportoenterostomy (HPE), impacts native liver survival. Typically, enteric bacterial flora are the source of infection, and fungal infections of the biliary tree are rare.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case Report<\/jats:title>\n                    <jats:p>\n                      We report the case of a 3\u2010year\u2010old female with BA status post Kasai HPE who developed\n                      <jats:italic>Aspergillus terreus<\/jats:italic>\n                      cholangitis (complicated by hepatic vein thrombus) identified through plasma metagenomic next\u2010generation sequencing (NGS) of microbial cell\u2010free deoxyribonucleic acid (DNA). Despite improvement in galactomannan (GM) antigen indices while on antifungal therapy with voriconazole and anticoagulation, she experienced complications with the extension of septic thrombus and persistent cholestasis; thrombus tissue sampling later confirmed the diagnosis and antimicrobial sensitivities. Ultimately, native liver explantation succeeded in achieving source control with sustained normalization of GM indices after the completion of voriconazole. Post\u2010transplant, she received routine immunosuppression and infection prophylaxis per institutional protocol and remains well without infectious complications more than 1\u2009year later.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>This case highlights the important role of newer molecular diagnostic tools in facilitating timely species\u2010level pathogen identification and initiation of targeted therapy (in this case, 35\u2009days prior to confirmed tissue diagnosis), particularly in circumstances where the risk\u2010to\u2010benefit ratio of invasive tissue sampling is unfavorable. Despite the significant morbidity associated with invasive fungal infection, transplantation followed by standard immunosuppression is a reasonable therapeutic option with successful outcomes in patients who are otherwise suitable transplant candidates.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/petr.70490","type":"journal-article","created":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T05:18:38Z","timestamp":1791782318000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Successful Liver Transplantation in a Child With Invasive\n                    <scp>\n                      <i>Aspergillus terreus<\/i>\n                    <\/scp>\n                    Cholangitis Identified via Plasma Metagenomic Next\u2010Generation Sequencing"],"prefix":"10.1111","volume":"30","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-8568-3329","authenticated-orcid":false,"given":"Katherine","family":"McAleese","sequence":"first","affiliation":[{"name":"Division of Infectious Diseases, Department of Pediatrics Boston Children's Hospital, Harvard Medical School  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-0548-964X","authenticated-orcid":false,"given":"Minoti","family":"Vather","sequence":"additional","affiliation":[{"name":"Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics Boston Children's Hospital, Harvard Medical School  Boston Massachusetts USA"},{"name":"Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics Hassenfeld Children's Hospital, New York University Langone Health, New York University Grossman School of Medicine  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7743-6422","authenticated-orcid":false,"given":"Sara O.","family":"Vargas","sequence":"additional","affiliation":[{"name":"Department of Pathology Boston Children's Hospital, Harvard Medical School  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-3452-0666","authenticated-orcid":false,"given":"Tanvi S.","family":"Sharma","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Pediatrics Boston Children's Hospital, Harvard Medical School  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2992-287X","authenticated-orcid":false,"given":"Scott A.","family":"Elisofon","sequence":"additional","affiliation":[{"name":"Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics Boston Children's Hospital, Harvard Medical School  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-4094-9681","authenticated-orcid":false,"given":"Geoffrey","family":"Guenther","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Department of Pediatrics Boston Children's Hospital, Harvard Medical School  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,11]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpeds.2005.12.054"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.21037\/tp.2016.10.08"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/MPG.0000000000002555"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpeds.2014.05.038"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1053\/jpsu.2002.32915"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciw326"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1007\/s15010\u2010020\u201001487\u20104"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11046\u2010010\u20109300\u2010y"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1086\/516288"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2014.08.010"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.fgb.2019.103247"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dku241"}],"container-title":["Pediatric 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