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Post-transplantation lymphoproliferative disorders: advances in diagnosis, prevention and management in children
1Division of Cardiology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
Insights
Post-transplantation lymphoproliferative disorders are a significant concern after pediatric thoracic transplants. Research highlights Epstein-Barr virus
Area of Science:
- Immunology
- Transplantation Medicine
- Oncology
Background:
- Improving survival rates in pediatric thoracic transplantation necessitate focus on long-term immunosuppression complications.
- Post-transplantation lymphoproliferative disorders (PTLD) represent a critical challenge in this patient population.
- Epstein-Barr virus (EBV) infection is recognized as a key factor in the development of most PTLD cases.
Purpose of the Study:
- To review the current understanding of PTLD in pediatric thoracic transplant recipients.
- To emphasize recent advancements in the diagnosis, prevention, and management of PTLD.
- To address the persistent challenges in PTLD nomenclature, outcome prediction, and treatment strategies.
Main Methods:
- Comprehensive literature review of PTLD in pediatric thoracic transplantation.
- Analysis of recent research on Epstein-Barr virus's role in PTLD etiology.
- Evaluation of current diagnostic, preventive, and therapeutic approaches.
Main Results:
- Significant progress has been made in understanding PTLD over the past 15 years, particularly the role of EBV.
- Despite advances, PTLD diagnosis, outcome prediction, and treatment remain challenging.
- Novel strategies for PTLD prevention are emerging.
Conclusions:
- PTLD remains a significant complication in pediatric thoracic transplantation, influenced by immunosuppression and EBV.
- Standardized nomenclature, validated outcome prediction tools, and prospective treatment trials are urgently needed.
- Focus on prevention strategies is a critical recent development in PTLD management.
Abstract:
With improving operative and postoperative survival after pediatric thoracic transplantation, attention has appropriately begun to focus on complications of long-term immunosuppression. One important complication is post-transplantation lymphoproliferative disorders. Much has been learnt about this spectrum of disorders over the last 15 years, including the pivotal role of primary Epstein-Barr virus infection in the etiology of most cases. Despite these advances, nomenclature remains confusing for the clinician, prediction of outcome is imprecise and treatment strategies are poorly defined. Indeed, no treatments have been subjected to comparative prospective clinical trials. Only recently has attention focussed on strategies for prevention. This article will review the current state of knowledge of post-transplantation lymphoproliferative disorders, with emphasis on recent advances in diagnosis, prevention and management.