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Posttransplantation lymphoproliferative disorders in pediatric thoracic organ recipients

G J Boyle1, M G Michaels, S A Webber

  • 1Department of Pediatrics, Children's Hospital of Pittsburgh, University of Pittsburgh, Pennsylvania, USA.

The Journal of Pediatrics
|August 1, 1997
PubMed

Insights

Posttransplantation lymphoproliferative disorders (PTLD) occur more frequently in pediatric thoracic organ transplant recipients. Primary Epstein-Barr virus (EBV) infection post-transplant is a major risk factor for PTLD development.

Area of Science:

  • Pediatric transplantation medicine
  • Immunology
  • Oncology

Background:

  • Posttransplantation lymphoproliferative disorders (PTLD) are a significant concern in organ transplant recipients.
  • Understanding PTLD in pediatric thoracic organ transplant recipients is crucial for improving outcomes.

Purpose of the Study:

  • To investigate the incidence, risk factors, clinical features, and outcomes of PTLD in children undergoing thoracic organ transplantation.
  • To identify key associations, such as Epstein-Barr virus (EBV) status, with PTLD development.

Main Methods:

  • Retrospective analysis of medical records for 120 pediatric patients surviving over one month post-thoracic organ transplant.
  • Review of PTLD diagnosis, clinical presentation, treatment strategies, and patient outcomes.

Main Results:

  • PTLD occurred in 11.7% of pediatric thoracic organ transplant recipients, with higher rates in lung/heart-lung recipients (19.5%) compared to heart recipients (7.7%).
  • Clinical presentations varied widely, from asymptomatic nodules to multiorgan failure. Primary EBV infection post-transplant was significantly associated with PTLD.
  • Treatment involving reduced immunosuppression and antiviral therapy led to PTLD resolution in eight patients; five deaths were attributed to PTLD.

Conclusions:

  • PTLD is more frequent in pediatric thoracic organ transplant recipients than in adults.
  • Primary EBV infection following transplantation is the primary risk factor for PTLD.
  • Management should include immunosuppression reduction and vigilant surveillance for PTLD in EBV-seronegative patients post-transplant.
Abstract

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