title: Graft rejection in pediatric liver transplant patients with Epstein-Barr viremia and post-transplant lymphoproliferative disease.
abstract: Treatment of primary EV and PTLD in pediatric LT recipients (pLT) involves IS reduction/cessation. Retrospective review of pLT at our institution from 2001-2009 was conducted to characterize risk factors for GR after EV/ PTLD. Of 184 pLT, EV occurred in 61 (33%) at mean 16.5 m (0-82) and PTLD in 18 (9.8%) at mean 17.7 m (3-78) post-LT. Median age at pLT was 11 m (1-245 m) and follow-up six yr. For EV, 86% underwent IS reduction and 51% received antivirals. GR occurred in 12 (27.9%) with EV and 15 (83.3%) after PTLD diagnosis (relative risk of GR for PTLD 2.98). GR treated with methylprednisolone bolus in half and/or oral IS in half. Following GR therapy, four had PTLD relapses, no graft loss and one EV patient required re-transplantation. GR history before EV was a risk factor for GR after EV (p = 0.024). GR at any point after pLT was a risk factor for PTLD (p = 0.001). Children with EV and GR prior to EV should be monitored closely for GR after IS reduction and GR is a significant risk factor for PTLD. Most children with PTLD eventually developed GR.
authors.affiliation: Department of Pediatrics, Mount Sinai Medical Center, New York, NY, USA.
authors.forename: Chana
authors.initials: C
authors.lastname: Weiner
authors.forename: Lauren
authors.initials: L
authors.lastname: Weintraub
authors.forename: Birte
authors.initials: B
authors.lastname: Wistinghausen
authors.forename: Juli
authors.initials: J
authors.lastname: Tomaino
authors.forename: Ronen
authors.initials: R
authors.lastname: Arnon
authors.forename: Nanda
authors.initials: N
authors.lastname: Kerkar
authors.forename: Tamir
authors.initials: T
authors.lastname: Miloh
mesh_terms: D000293:Adolescent; D000998:Antiviral Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D020031:Epstein-Barr Virus Infections / Q000209:etiology* / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000188:drug therapy / Q000209:etiology* / Q000276:immunology / Q000821:virology; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007223:Infant; D016031:Liver Transplantation / Q000276:immunology*; D008232:Lymphoproliferative Disorders / Q000209:etiology* / Q000276:immunology / Q000517:prevention & control / Q000821:virology; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use; D011183:Postoperative Complications / Q000276:immunology / Q000628:therapy / Q000821:virology; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D014766:Viremia / Q000209:etiology* / Q000628:therapy; D055815:Young Adult
chemical_list: D000998:Antiviral Agents; D007166:Immunosuppressive Agents; D008775:Methylprednisolone