title: Clinicopathologic features of post-transplant lymphoproliferative disorders arising after pediatric small bowel transplant.
abstract: Few studies examined the clinicopathologic features of PTLD arising in pediatric SBT patients. Particularly, the association between ATG and PTLD in this population has not been described. Retrospective review of 81 pediatric patient charts with SBT--isolated or in combination with other organs--showed a PTLD incidence of 11%, occurring more frequently in females (median age of four yr) and with clinically advanced disease. Monomorphic PTLD was the most common histological subtype. There was a significant difference in the use of ATG between patients who developed PTLD and those who did not (p < 0.01); a similar difference was seen with the use of sirolimus (p < 0.001). These results suggested a link between the combination of ATG and sirolimus and development of more clinically and histologically advanced PTLD; however, the risk of ATG by itself was not clear. EBV viral loads were higher in patients with PTLD, and median time between detection of EBV to PTLD diagnosis was three months. However, viral loads at the time of PTLD diagnosis were most often lower than at EBV detection, thereby raising questions on the correlation between decreasing viral genomes and risk of PTLD.
authors.affiliation: Department of Pathology, Medstar Georgetown University Hospital, Washington, DC, USA.
authors.forename: S
authors.initials: S
authors.lastname: Nassif
authors.forename: S
authors.initials: S
authors.lastname: Kaufman
authors.forename: S
authors.initials: S
authors.lastname: Vahdat
authors.forename: N
authors.initials: N
authors.lastname: Yazigi
authors.forename: B
authors.initials: B
authors.lastname: Kallakury
authors.forename: E
authors.initials: E
authors.lastname: Island
authors.forename: M
authors.initials: M
authors.lastname: Ozdemirli
mesh_terms: D000293:Adolescent; D000961:Antilymphocyte Serum / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D005260:Female; D015321:Gene Rearrangement; D016679:Genome, Viral; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D017403:In Situ Hybridization; D007223:Infant; D007410:Intestinal Diseases / Q000150:complications / Q000628:therapy*; D007421:Intestine, Small / Q000637:transplantation*; D008223:Lymphoma / Q000150:complications / Q000209:etiology; D008232:Lymphoproliferative Disorders / Q000150:complications / Q000209:etiology*; D008297:Male; D011183:Postoperative Complications; D012189:Retrospective Studies; D012306:Risk; D020123:Sirolimus / Q000627:therapeutic use; D045567:VDJ Recombinases / Q000235:genetics; D019562:Viral Load; D055815:Young Adult
chemical_list: D000961:Antilymphocyte Serum; D007166:Immunosuppressive Agents; C512542:thymoglobulin; D045567:VDJ Recombinases; D020123:Sirolimus
keywords: pediatric; post-transplant lymphoma; sirolimus; small bowel; thymoglobulin; viral load