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Posttransplantation lymphoproliferative disorder in pediatric liver transplantation
1Department of Surgery, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, Korea.
Insights
Pediatric liver transplant recipients who are Epstein-Barr virus (EBV)-naive and receive EBV-positive grafts face a high risk of developing posttransplantation lymphoproliferative disorder (PTLD). Early identification of EBV infection is crucial for managing PTLD risk.
Area of Science:
- Pediatric Hepatology
- Transplantation Immunology
- Oncology
Background:
- Posttransplantation lymphoproliferative disorder (PTLD) is a serious complication following organ transplantation.
- Pediatric liver transplantation involves unique challenges and risks, including PTLD.
- Understanding risk factors is crucial for preventing and managing PTLD in pediatric recipients.
Purpose of the Study:
- To evaluate the clinical features and risk factors associated with PTLD in pediatric liver transplant recipients.
- To identify specific patient and donor characteristics that increase PTLD risk.
- To inform clinical practice and improve outcomes for children undergoing liver transplantation.
Main Methods:
- Retrospective review of 35 pediatric liver transplant recipients (1996-2002).
- Patients categorized into high-risk (EBV-naive recipients of EBV-positive grafts) and low-risk groups based on serology.
- Clinical data, including PTLD development, timing, and symptoms, were analyzed.
Main Results:
- Five of 41 patients (12.2%) developed PTLD, all within the high-risk group (31.3% incidence).
- PTLD diagnosis occurred at a median of 9.8 months post-transplant, with primary EBV infection around 6 months.
- Common symptoms included anemia, hypoalbuminemia, fever, diarrhea, and gastrointestinal bleeding.
Conclusions:
- EBV-seronegative recipients of EBV-seropositive grafts are at high risk for PTLD.
- Young age (around 1 year) and intensive immunosuppression are associated with PTLD development.
- Primary EBV infection approximately 6 months post-transplant is a key factor in PTLD pathogenesis.
Introduction:
The aim of this study was to evaluate the clinical features of risk factors for posttransplantation lymphoproliferative disorder (PTLD) in pediatric liver transplantation.
Materials And Methods:
Between June 1996 and June 2002, among 41 pediatric patients who underwent liver transplantation, 7 died in the postoperative period. Thirty-five patients, including 1 patient who died of PTLD, were reviewed. Based on the serology results, patients were divided into a high-risk group (EBV-naive recipients of EBV-positive grafts) and a low-risk group (patients other than those in the high-risk group).
Results:
Five of 41 patients (12.2%) developed PTLD. All of them belonged to the high-risk group. The incidence of PTLD in the high-risk group was 31.3% (5 of 16). The mean duration between operation and diagnosis for PTLD was 9.8 months. Primary EBV infection developed at a median of 6 months after transplantation. Three of 5 patients developed rejection before the diagnosis of PTLD. One patient was diagnosed with laryngeal and gastrointestinal PTLD, whereas the other 4 had gastrointestinal PTLD. They experienced the following symptoms and signs: anemia (100%), hypoalbuminemia (100%), fever (80%), diarrhea (80%), gastrointestinal bleeding (80%), and anorexia (60%).
Conclusion:
The common features of PTLD development were as follows: (1) EBV-positive donors placed into EBV-naive recipients, (2) primary EBV infection approximately 6 months after transplantation, (3) young age, 1 year old at operation, and (4) requirement for intensive posttransplantation immunosuppression.
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