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Post-transplantation lymphoproliferative disorder in living-donor liver transplantation: a single-center experience
Chikashi Nakanishi1, Naoki Kawagishi, Satoshi Sekiguchi
1Division of Advanced Surgical Science and Technology, Graduate School of Medicine, Tohoku University, 1-1 Seiryou-machi, Aobaku, Sendai, 980-8574, Japan. chikashi-n@world.ocn.ne.jp
Insights
Post-transplantation lymphoproliferative disorder (PTLD) is a serious complication after liver transplants in children. Prompt treatment, including immunosuppression reduction or rituximab, led to good outcomes in all five pediatric cases studied.
Area of Science:
- Hepatology
- Pediatric Oncology
- Immunology
Background:
- Post-transplantation lymphoproliferative disorder (PTLD) is a severe complication following organ transplantation, particularly in pediatric recipients.
- This study examines PTLD in pediatric patients who underwent living-donor liver transplantation (LDLT).
Purpose of the Study:
- To evaluate the incidence and outcomes of PTLD in pediatric patients after LDLT.
- To analyze treatment strategies and patient responses for PTLD in this cohort.
Main Methods:
- Retrospective review of 78 pediatric patients (<18 years) undergoing LDLT between July 1991 and December 2009.
- Analysis of patient demographics, transplant characteristics, and PTLD diagnosis and treatment.
Main Results:
- PTLD occurred in five pediatric patients, an incidence of 3.8%.
- No significant differences were found between PTLD and non-PTLD groups regarding age, sex, transplant reason, immunosuppression, EBV status, or rejection.
- Treatment responses varied: reduction in immunosuppression for lymphadenopathy/GI PTLD, rituximab for GI PTLD, and chemotherapy/rituximab/surgery for diffuse large B-cell lymphoma.
Conclusions:
- PTLD, while life-threatening, is manageable with timely and appropriate interventions.
- Pediatric patients with PTLD after LDLT demonstrated good outcomes with current treatment modalities.
Background:
Post-transplantation lymphoproliferative disorder (PTLD) is a group of life-threatening complications of organ transplantation, which occurs most frequently in pediatric patients. This retrospective study evaluates a single-institution experience of five cases of PTLD after living-donor liver transplantation (LDLT).
Patients And Method:
We reviewed the records of 78 pediatric patients (<18 years old) and 54 adult patients, who underwent LDLT between July 1991 and December 2009.
Result:
PTLD was diagnosed in five pediatric patients, yielding an overall incidence of 3.8%. There were no significant differences between the pediatric patients with and those without PTLD in terms of their age, sex, reason for transplantation, calcineurin inhibitor, Epstein-Barr virus (EBV) serostatus, ABO compatibility, lymphocyte cross-matching, or episodes of biopsy proven rejection. Two patients with abdominal lymphadenopathy and one with gastrointestinal PTLD responded to a reduction in immunosuppression. Treatment with rituximab was necessary for another gastrointestinal PTLD patient. Diffuse large-B-cell lymphoma was diagnosed in one patient with mediastinal and lung masses. This patient was treated with chemotherapy and rituximab, followed by surgical resection. All patients survived and no evidence of recurrence has been found since.
Conclusion:
Although PTLD is potentially life-threatening, it can be managed by appropriate and prompt treatment, with a good outcome.
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