Prevention of post-transplant lymphoproliferative disorder in pediatric kidney transplant recipients

Related Experiment Video

Updated: Jun 11, 2025

Trans-vivo Delayed Type Hypersensitivity Assay for Antigen Specific Regulation
11:49

Trans-vivo Delayed Type Hypersensitivity Assay for Antigen Specific Regulation

Published on: May 2, 2013

16.0K

Shirley Pollack1,2, Moran Plonsky3,4, Rami Tibi4

  • 1Technion Faculty of Medicine, Haifa, Israel. s_pollack@technion.ac.il.

Pediatric Nephrology (Berlin, Germany)
|October 7, 2024
PubMed

Insights

Preventive rituximab therapy may safely clear Epstein-Barr virus (EBV) DNA and prevent post-transplant lymphoproliferative disorder (PTLD) in pediatric kidney transplant recipients (PKTR), especially those EBV-naïve pre-transplant.

Area of Science:

  • Immunology
  • Transplantation Medicine
  • Virology

Background:

  • Post-transplant lymphoproliferative disorder (PTLD) is a serious complication following solid organ transplantation (SOT) and hematopoietic stem cell transplantation (HSCT).
  • Epstein-Barr virus (EBV) infection is a precursor to PTLD in most cases.
  • Rituximab, an anti-CD20 antibody, targets EBV-infected B-lymphocytes and is used for PTLD prevention in HSCT but not established in SOT.

Purpose of the Study:

  • To evaluate the safety and efficacy of preventive rituximab therapy for Epstein-Barr virus (EBV) DNAemia in pediatric kidney transplant recipients (PKTR).
  • To assess EBV clearance and PTLD prevention strategies in EBV-seronegative PKTR.

Main Methods:

  • Routine EBV-PCR surveillance was performed on pediatric kidney transplant recipients (PKTR).
  • Patients with rising EBV viral loads, unresponsive to immunosuppression dose reduction, received preventive rituximab therapy.
  • Outcomes including EBV PCR clearance and complications were monitored.

Main Results:

  • Eleven percent (7/65) of PKTR developed asymptomatic EBV DNAemia between 120-720 days post-transplant.
  • Seventy-one percent (5/7) of patients with EBV DNAemia were EBV-seronegative pre-transplant.
  • All patients treated with rituximab achieved EBV PCR clearance with minimal complications.

Conclusions:

  • Pediatric kidney transplant recipients (PKTR) who are EBV-naïve pre-transplant have a higher incidence of EBV DNAemia.
  • Immunosuppression dose reduction is less effective for EBV clearance in EBV-seronegative PKTR.
  • Preventive rituximab therapy appears safe and effective for EBV clearance and PTLD prevention in PKTR.
Abstract

Keywords:
EBV infectionGraft survivalPediatric kidney transplantPost-transplant lymphoproliferative disorderRituximab

More Related Videos

Digital Home-Monitoring of Patients after Kidney Transplantation: The MACCS Platform07:13

Digital Home-Monitoring of Patients after Kidney Transplantation: The MACCS Platform

Published on: April 12, 2021

4.2K
In Vitro and In Vivo Assessment of T, B and Myeloid Cells Suppressive Activity and Humoral Responses from Transplant Recipients18:48

In Vitro and In Vivo Assessment of T, B and Myeloid Cells Suppressive Activity and Humoral Responses from Transplant Recipients

Published on: August 12, 2017

14.3K

Related Concept Videos

Kidney Transplant II: Surgical Procedure01:26

Kidney Transplant II: Surgical Procedure

Preoperative ManagementThe primary goals of preoperative management in kidney transplantation are to optimize the patient’s metabolic state and prepare them for surgery through diet adjustments, necessary dialysis, and tailored medical treatment. This phase also involves comprehensive infection screening and patient education about the surgical procedure and postoperative care to improve outcomes and adherence.Medical ManagementA comprehensive evaluation is required for both the living...
2
Kidney Transplant I: Introduction01:28

Kidney Transplant I: Introduction

A kidney transplant is a surgical approach that involves replacing a non-functioning kidney with a healthy one from a donor. This procedure is often a treatment option for end-stage renal disease (ESRD) patients. The method requires careful recipient selection, including evaluating various medical and psychosocial factors. These criteria vary between transplant centers but generally include assessments of the patient's overall health, adherence to medical recommendations, and lifestyle...
2
Kidney Transplant III: Nursing Management01:16

Kidney Transplant III: Nursing Management

Postoperative Nursing Management for Kidney Transplant PatientsPostoperative nursing management care includes monitoring the surgical site, encouraging early movement, and promoting lung health through breathing exercises. Nurses also administer prescribed medications like H2-blockers, such as famotidine, or proton pump inhibitors, like omeprazole, to help prevent gastrointestinal ulcers and bleeding. Fungal infections in the mouth and bladder can result from immunosuppressive and antibiotic...
3
Bone Marrow Sampling and Transplants01:22

Bone Marrow Sampling and Transplants

Bone marrow transplant is a potential cure for several diseases, including cancer and specific genetic disorders. Notably, this procedure is applicable for patients suffering from aplastic anemia, certain types of leukemia, severe combined immunodeficiency disease (SCID), Hodgkin's disease, non-Hodgkin's lymphoma, multiple myeloma, thalassemia, sickle-cell disease, and certain cancers.
The transplant begins with high doses of chemotherapy and radiation treatment, which aim to destroy...
313
Acute Kidney Injury IV: Diagnostic Studies and Prevention01:30

Acute Kidney Injury IV: Diagnostic Studies and Prevention

Accurate diagnosis and effective prevention are critical in managing Acute Kidney Injury (AKI), which is linked to high mortality rates ranging from 10% to 80%. Timely recognition of at-risk patients and careful monitoring can significantly reduce the likelihood of kidney damage.Diagnostic Assessments:The diagnostic process starts with a comprehensive medical history to identify prerenal, intrarenal, and postrenal causes.Prerenal causes, such as dehydration, hypotension, or blood loss, should...
8