{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T04:48:12Z","timestamp":1791953292754,"version":"4.3.4"},"reference-count":12,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T00:00:00Z","timestamp":1791849600000},"content-version":"vor","delay-in-days":12,"URL":"http:\/\/creativecommons.org\/licenses\/by\/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>Normothermic machine perfusion (NMP) is an emerging strategy for pediatric liver transplantation, but pediatric\u2010specific viability criteria remain undefined. Lactate clearance, extrapolated from adult protocols, is a central marker of allograft function. In our pediatric NMP (pNMP) experience, we observed a novel pattern: initial clearance followed by secondary rise, termed rebound lactic acidosis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We retrospectively reviewed pediatric liver allografts preserved on the TransMedics Organ Care System at two centers (January 2025 through June 2026). After excluding donors &gt;\u200935\u2009kg, 18 perfusions (17 transplants) were classified as rebound lactic acidosis (lactate rise &gt;\u20090.5\u2009mmol\/L after initial clearance) or sustained clearance. Rebound cases were characterized by lactate kinetics, perfusion parameters, acid\u2013base status, bile production, histology, and recipient outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Six allografts demonstrated rebound, with onset 1.0\u20136.6\u2009h into perfusion. All sustained bile production throughout perfusion. Circuit alkalosis temporally correlated with rebound in three cases and improved with gas flow reduction. The first allograft was discarded; the remaining five were transplanted, including one perfused for 35.5\u2009h. Recipients had elevated POD1 transaminases and INR that normalized by POD7; three are discharged home and two remain hospitalized, all with functioning allografts (follow\u2010up up to 312\u2009days).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Rebound lactic acidosis during pNMP may not indicate allograft nonviability and may be ameliorated by modifying circuit perfusion or pH. Lactate kinetics should be interpreted within a multiparametric viability framework incorporating perfusion adequacy, acid\u2013base status, bile production, liver function, and histology. Pediatric\u2010specific criteria are needed to safely expand the donor pool.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/petr.70500","type":"journal-article","created":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T04:15:07Z","timestamp":1791951307000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Navigating Uncertainty: Characterizing Rebound Lactic Acidosis in Pediatric Normothermic Machine Perfusion"],"prefix":"10.1111","volume":"30","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5461-628X","authenticated-orcid":false,"given":"Chun\u2010Sing","family":"Huang","sequence":"first","affiliation":[{"name":"Division of Abdominal Transplantation, Michael E. DeBakey Department of Surgery Baylor College of Medicine  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-1181-9269","authenticated-orcid":false,"given":"Alonzo","family":"Needum","sequence":"additional","affiliation":[{"name":"School of Medicine Baylor College of Medicine  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-1533-6360","authenticated-orcid":false,"given":"Sarah G.","family":"Van Winkle","sequence":"additional","affiliation":[{"name":"Division of Abdominal Transplantation, Michael E. DeBakey Department of Surgery Baylor College of Medicine  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-1138-8372","authenticated-orcid":false,"given":"Gwendolyn B.","family":"Henry","sequence":"additional","affiliation":[{"name":"School of Medicine Baylor College of Medicine  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-4502-3448","authenticated-orcid":false,"given":"Rayhan Neil","family":"Jhanji","sequence":"additional","affiliation":[{"name":"School of Medicine Baylor College of Medicine  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9256-9429","authenticated-orcid":false,"given":"Emma","family":"Hills","sequence":"additional","affiliation":[{"name":"Division of Abdominal Transplantation, Michael E. DeBakey Department of Surgery Baylor College of Medicine  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8422-7039","authenticated-orcid":false,"given":"Naseem","family":"Ravanbakhsh","sequence":"additional","affiliation":[{"name":"Division of Hepatology Texas Children's Hospital, Baylor College of Medicine  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2979-0598","authenticated-orcid":false,"given":"Abbas","family":"Rana","sequence":"additional","affiliation":[{"name":"Division of Abdominal Transplantation, Michael E. DeBakey Department of Surgery Baylor College of Medicine  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0899-7234","authenticated-orcid":false,"given":"Kyle","family":"Soltys","sequence":"additional","affiliation":[{"name":"Division of Abdominal Transplantation, Children's Hospital of Pittsburgh University of Pittsburgh School of Medicine  Pittsburgh Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2624-8632","authenticated-orcid":false,"given":"George","family":"Mazariegos","sequence":"additional","affiliation":[{"name":"Division of Abdominal Transplantation, Children's Hospital of Pittsburgh University of Pittsburgh School of Medicine  Pittsburgh Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1289-4692","authenticated-orcid":false,"given":"N. Thao N.","family":"Galv\u00e1n","sequence":"additional","affiliation":[{"name":"Division of Abdominal Transplantation, Michael E. DeBakey Department of Surgery Baylor College of Medicine  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2794-1156","authenticated-orcid":false,"given":"John","family":"Goss","sequence":"additional","affiliation":[{"name":"Division of Abdominal Transplantation, Michael E. DeBakey Department of Surgery Baylor College of Medicine  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,13]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/TP.0000000000005570"},{"issue":"3","key":"e_1_2_10_3_1","doi-asserted-by":"crossref","first-page":"493","DOI":"10.1002\/lt.26317","article-title":"Assessment of Deceased Brain Dead Donor Liver Grafts via Normothermic Machine Perfusion: Lactate Clearance Time Threshold Can be Safely Extended to 6 Hours","volume":"28","author":"Hann A.","year":"2022","journal-title":"Liver Transplantation"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajt.2026.03.030"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.5500\/wjt.v15.i4.104111"},{"issue":"8","key":"e_1_2_10_6_1","doi-asserted-by":"crossref","first-page":"S58","DOI":"10.1016\/j.ajt.2025.07.110","article-title":"Split Liver Transplantation Using Machine Perfusion in Pediatric Recipients","volume":"25","author":"Jensen A.","year":"2026","journal-title":"American Journal of Transplantation"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/petr.70202"},{"issue":"10","key":"e_1_2_10_8_1","doi-asserted-by":"crossref","first-page":"1453","DOI":"10.1002\/lt.25291","article-title":"Development of Clinical Criteria for Functional Assessment to Predict Primary Nonfunction of High\u2010Risk Livers Using Normothermic Machine Perfusion","volume":"24","author":"Mergental H.","year":"2018","journal-title":"Liver Transplantation"},{"key":"e_1_2_10_9_1","doi-asserted-by":"crossref","DOI":"10.1038\/s41467-020-16251-3","article-title":"Transplantation of Discarded Livers Following Viability Testing With Normothermic Machine Perfusion [VITTAL Trial]","volume":"11","author":"Mergental H.","year":"2020","journal-title":"Nature Communications"},{"issue":"3","key":"e_1_2_10_10_1","article-title":"Predictive Value of Early Lactate (<6 h) During Normothermic Machine Perfusion and Outcome After Liver Transplantation: Results From a Multicentre Study","volume":"8","author":"Hofmann J.","year":"2024","journal-title":"BJS Open"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamasurg.2021.6781"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1097\/txd.0000000000001823"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/liv.13404"}],"container-title":["Pediatric Transplantation"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/petr.70500","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/petr.70500","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/petr.70500","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T04:15:09Z","timestamp":1791951309000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/petr.70500"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10]]},"references-count":12,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2026,10]]}},"alternative-id":["10.1111\/petr.70500"],"URL":"https:\/\/doi.org\/10.1111\/petr.70500","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":"2026-07-29","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-10-05","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-10-13","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70500"}}