Post-transplantation lymphoproliferative disorder in pediatric kidney-transplant recipients - a national study.
PTLD is the most common malignancy in pediatric kidney-transplant recipients. We examined the prevalence, clinical features, and outcome of PTLD in Israel. Twelve (4.4%) of 272 pediatric (<19 yr) kidney-transplant recipients retrieved from a search of the NIKTR for 1991-2008 had acquired PTLD at a median of 3.2 yr post-transplantation. PTLD-affected patients were younger at transplantation (4.2 vs. 12.5 yr, p = 0.02), had a higher rate of OKT3 therapy for acute rejection (25% vs. 4%, p = 0.015), and 5/12 were EBV-seropositive at transplantation. Graft dysfunction was the presenting sign in six (50%). PTLD was predominantly abdominal (83%) and B-cell type (67%); T-cell PTLD occurred exclusively in EBV-seropositive patients. Treatment consisted of immunosuppression cessation (6/12, 50%), antiviral agents (7/12, 58%), anti-CD20 monoclonal antibodies (4/12, 33%), and chemotherapy (6/12, 50%). Survival was 100% in the EBV-naïve patients and 40% in the EBV-seropositive patients. Graft loss occurred in three of eight survivors (37.5%). PTLD-associated mortality risk was older age: 11.2 vs. 3.4 yr, longer dialysis: 15 vs. 6.5 months, T-cell type disease (75%), later PTLD onset: 6.35 vs. 1.9 yr post-transplantation and era of transplantation (43% mortality before vs. 20% after 2001). Pretransplantation EBV-seronegative status might confer a survival benefit with early detected PTLD. EBV-seropositive patients are at risk for aggressive late-onset lethal PTLD.
Institute of Nephrology, Schneider Children's Medical Center of Israel, Petach Tikva, Israel. acleper@zahav.net.il
Roxana
R
Cleper
Efrat
E
Ben Shalom
Daniel
D
Landau
Irith
I
Weissman
Irit
I
Krause
Osnat
O
Konen
Ruth
R
Rahamimov
Eytan
E
Mor
Nathan
N
Bar-Nathan
Yaakov
Y
Frishberg
Miriam
M
Davidovits
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007223:Infant; D007557:Israel; D016030:Kidney Transplantation / Q000009:adverse effects*; D008232:Lymphoproliferative Disorders / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D008297:Male; D010372:Pediatrics / Q000379:methods; D011184:Postoperative Period; D015995:Prevalence; D012042:Registries; D051437:Renal Insufficiency / Q000150:complications* / Q000628:therapy*; D012306:Risk; D013601:T-Lymphocytes / Q000166:cytology; D013997:Time Factors; D016896:Treatment Outcome
D007166:Immunosuppressive Agents