The changing face of post-transplant lymphoproliferative disease in the era of molecular EBV monitoring.
Pediatric PTLD is often associated with primary EBV infection and immunosuppression. The aim was to retrospectively review the spectrum of histologically documented PTLD for two time intervals differentiated by changes in use of molecular EBV monitoring. Eleven of 146 patients (7.5%) in 2001-2005 (Era A) and 10 of 92 (10.9%) in 1993-1997 (Era B) were diagnosed with PTLD. The median age at liver transplantation (0.8 and 0.9 yr, respectively) and the median duration between liver transplant and diagnosis of PTLD (0.6 and 0.7 yr, respectively) were similar in both eras. However, patients in Era A presented with significantly less advanced histological disease compared to patients in Era B (p=0.03). Specifically, nine patients (82%) in Era A had Pl hyperplasia/polymorphic PTLD, whereas in Era B, six had advanced histological disease (five monomorphic and one unclassified). Three transplant recipients in Era B died secondary to PTLD, whereas there were no PTLD-related deaths in Era A (p=0.03). Heightened awareness of risk for PTLD, alterations in baseline immunosuppression regimens, implementation of molecular EBV monitoring, pre-emptive reduction in immunosuppression and improved therapeutic options may have all contributed to a milder PTLD phenotype and improved clinical outcomes.
Kerkar
Nanda
N
Department of Surgery, Mount Sinai School of Medicine, Recanati Miller Transplant Institute, New York, NY 10029, USA. nanda.kerkar@mountsinai.org
Morotti
Raffaella A
RA
Madan
Rebecca P
RP
Shneider
Benjamin
B
Herold
Betsy C
BC
Dugan
Christina
C
Miloh
Tamir
T
Karabicak
Ilhan
I
Strauchen
James A
JA
Emre
Sukru
S
D002648:Child; D002675:Child, Preschool; D020031:Epstein-Barr Virus Infections / Q000453:epidemiology* / Q000473:pathology; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use; D016031:Liver Transplantation; D008232:Lymphoproliferative Disorders / Q000453:epidemiology* / Q000473:pathology / Q000821:virology; D016133:Polymerase Chain Reaction; D011183:Postoperative Complications / Q000453:epidemiology* / Q000473:pathology / Q000821:virology; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D014481:United States / Q000453:epidemiology
D007166:Immunosuppressive Agents