Immunosuppression Withdrawal in Pediatric Liver Transplant Recipients With Posttransplant Lymphoproliferative...

BACKGROUND Posttransplant lymphoproliferative disorder (PTLD) is a serious complication following pediatric liver transplantation. Reduction of immunosuppression is a cornerstone of PTLD management; however, the feasibility and safety of complete immunosuppression withdrawal (ISW) in this setting remain unclear. MATERIAL AND METHODS We retrospectively reviewed 6 pediatric liver transplant recipients diagnosed with PTLD who subsequently underwent complete ISW at our center between 2013 and 2019. Demographic characteristics, clinical features, pathological classification, treatments, and follow-up outcomes were analyzed. RESULTS The cohort included 6 children (4 females and 2 males) who underwent liver transplantation at a median age of 8 months. PTLD subtypes included infectious mononucleosis-type (n=3), polymorphic PTLD (n=1), Burkitt lymphoma (n=1), and classical Hodgkin lymphoma-like PTLD (n=1). All patients achieved complete remission following multimodal therapy. The median interval from transplantation to initiation of ISW was 35 months. During a median follow-up of 52 months after ISW, 4 patients maintained stable graft function without biopsy-proven rejection, whereas 2 developed rejection-related complications, both of which resolved after restart of low-dose immunosuppressive therapy. No graft loss or PTLD recurrence occurred. CONCLUSIONS In carefully selected pediatric liver transplant recipients with PTLD, supervised ISW may be achieved without irreversible graft injury. However, a substantial risk of rejection remains, highlighting the importance of close clinical and histological monitoring.