title: Influence of Posttransplant Lymphoproliferative Disorder on Survival in Children After Heart Transplantation.
abstract: The influence of posttransplant lymphoproliferative disorder (PTLD) on long-term survival in children after heart transplantation (HTx) is not well studied. The United Network for Organ Sharing database was queried from 1987 to 2013 for data on PTLD in relation to induction immunosuppression and recipient Epstein-Barr virus status in children (<18 years of age) who underwent HTx. Of 6818 first-time pediatric heart transplants, 5169 had follow-up data on posttransplant malignancy, with 360 being diagnosed with PTLD. Univariate Cox analysis identified diminished survival after PTLD onset using a time-varying measure of PTLD (HR 2.208; 95 % CI 1.812, 2.689; p < 0.001), although Kaplan-Meier survival functions found no difference in survival between the group ever diagnosed with PTLD and the non-PTLD reference group (log-rank test: χ 1 (2)  = 0.02; p = 0.928). A multivariate Cox model found a greater mortality hazard associated with the development of PTLD after adjusting for recipient EBV seronegativity and other covariates (HR 3.024; 95 % CI 1.902, 4.808; p < 0.001). Induction immunosuppression at time of HTx did not significantly influence posttransplant mortality. The development of PTLD adversely influenced long-term survival in children after HTx after adjusting for confounding variables.
authors.affiliation: Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA. hayes.705@osu.edu.|Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, OH, USA. hayes.705@osu.edu.|Section of Pulmonary Medicine, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA. hayes.705@osu.edu.
authors.forename: Don
authors.initials: D
authors.lastname: Hayes
authors.affiliation: Department of Surgery, The Ohio State University College of Medicine, Columbus, OH, USA.|Department of Surgery, Nationwide Children's Hospital, Columbus, OH, USA.
authors.forename: Christopher K
authors.initials: CK
authors.lastname: Breuer
authors.affiliation: Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA.|Section of Hematology, Oncology & Bone Marrow Transplantation, Nationwide Children's Hospital, Columbus, OH, USA.
authors.forename: Edwin M
authors.initials: EM
authors.lastname: Horwitz
authors.affiliation: Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA.|Section of Cardiology, Nationwide Children's Hospital, Columbus, OH, USA.|Section of Critical Care Medicine, Nationwide Children's Hospital, Columbus, OH, USA.
authors.forename: Andrew R
authors.initials: AR
authors.lastname: Yates
authors.affiliation: Department of Anesthesiology, The Ohio State University College of Medicine, Columbus, OH, USA.|Section of Critical Care Medicine, Nationwide Children's Hospital, Columbus, OH, USA.|Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA.
authors.forename: Joseph D
authors.initials: JD
authors.lastname: Tobias
authors.affiliation: Department of Surgery, The Ohio State University College of Medicine, Columbus, OH, USA.|Department of Cardiothoracic Surgery, Nationwide Children's Hospital, Columbus, OH, USA.
authors.forename: Toshiharu
authors.initials: T
authors.lastname: Shinoka
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual; D020031:Epstein-Barr Virus Infections / Q000453:epidemiology*; D005260:Female; D016027:Heart Transplantation / Q000401:mortality*; D004854:Herpesvirus 4, Human; D006801:Humans; D007223:Infant; D053208:Kaplan-Meier Estimate; D008232:Lymphoproliferative Disorders / Q000453:epidemiology*; D008297:Male; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000453:epidemiology*; D016016:Proportional Hazards Models; D012307:Risk Factors; D015996:Survival Rate; D014481:United States
keywords: Children; Heart transplantation; Pediatrics; Posttransplant lymphoproliferative disorder; Survival