Post-transplant lymphoproliferative disease in children.
Epstein-Barr virus (EBV)-driven post-transplant lymphoproliferative disease (PTLD) is an important cause of morbidity and mortality following transplantation, and it occurs more frequently in children than in adults. Of 22 (5%) children at our institution who developed tissue-proven PTLD 1-60 months (mean 16.5 months) following organ transplant, 11 died: nine of these 22 patients developed PTLD between 1989 and 1993, and seven (78%) died; the remaining 13 developed PTLD between 1994 and 1998, and four (31%) died (p = 0.08). All nine patients who developed PTLD < 6 months after transplant died, but 11 of 13 patients who manifested disease > or = 6 months after transplant survived (p = 0.0002). Ten of 11 (91%) survivors, but only two of eight (25%) children who died, had serologic evidence of EBV infection at the time of PTLD diagnosis (p = 0.04). EBV seroconversion identified patients at risk for developing PTLD, but also characterized patients with sufficient immune function to survive EBV-related lymphoid proliferation. In situ hybridization for EBER1 mRNA was diagnostically helpful because it detected EBV in tissue sections of all 20 patients with B-cell PTLD, including those with negative serology.
Collins
M H
MH
Department of Pathology and Laboratory Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA, USA. colv5q@chmcc.org
Montone
K T
KT
Leahey
A M
AM
Hodinka
R L
RL
Salhany
K E
KE
Kramer
D L
DL
Deng
C
C
Tomaszewski
J E
JE
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D004854:Herpesvirus 4, Human / Q000302:isolation & purification; D006801:Humans; D016867:Immunocompromised Host; D015994:Incidence; D007223:Infant; D016015:Logistic Models; D008232:Lymphoproliferative Disorders / Q000209:etiology* / Q000401:mortality / Q000821:virology; D008297:Male; D012367:RNA, Viral / Q000097:blood; D014181:Transplantation Immunology; D016896:Treatment Outcome
D012367:RNA, Viral