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Ramos-Gonzalez G, Crum R, Allain A, Agur T, O'Melia L, Staffa S, Burchett SK, Siegele B, Weinberg O, Rodig NM, Fawaz R, Singh TP, Freiberger DA, Bae Kim H. Presentation and outcomes of post-transplant lymphoproliferative disorder at a single institution pediatric transplant center. Pediatr Transplant 2022; 26:e14268. [PMID: 35304794 DOI: 10.1111/petr.14268] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 01/06/2022] [Accepted: 03/01/2022] [Indexed: 12/22/2022]
Abstract
BACKGROUND This study aimed to characterize features present at the time of diagnosis and describe outcomes in patients with post-transplant lymphoproliferative disorder (PTLD) following pediatric solid organ transplantation. METHODS We performed a retrospective review of solid organ transplant patients who developed pathologically confirmed PTLD at our center from 2006 to 2016. RESULTS Of 594 patients included in this study, 41(6.9%) were diagnosed with PTLD. Median age at transplant was 5.6(IQR 1.7-16.1) years. Proportion of PTLD cases by organ transplanted and median time (IQR) to disease onset were: heart 11/144(7.6%) at 13.6(8.5-55.6) months, lung 7/52(13.5%) at 9.1(4.9-35) months, kidney 8/255(3.1%) at 39.5(13.9-57.1) months, liver 12/125(9.6%) at 7.7(5.5-22) months, intestine 0/4(0%), and multi-visceral 3/14(21.4%) at 5.4(5.4-5.6) months. No significant correlation was seen between recipient EBV status at transplant and timing of development of PTLD. There were six early lesions, 15 polymorphic, 19 monomorphic, and one uncharacterizable PTLD. Following immunosuppression reduction, 30 patients received rituximab, and 14 required chemotherapy. At median 25(IQR 12-53) months follow-up from the onset of PTLD, eight patients died secondary to transplant related complications, three are alive with active disease, and 30 have no evidence of disease. CONCLUSION PTLD is a significant complication following pediatric solid organ transplantation. EBV levels in conjunction with symptomatic presentation following transplant may assist in detection of PTLD. Most patients can achieve long-term disease-free survival through immunosuppression reduction, anti-CD20 treatment, and chemotherapy in refractory cases.
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Affiliation(s)
| | - Robert Crum
- Department of Surgery, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Alec Allain
- Department of Surgery, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Timna Agur
- Department of Nephrology and Hypertension, Rabin Medical Center, Petah Tikva, Israel
| | - Laura O'Melia
- Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Steven Staffa
- Department of Surgery, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Sandra K Burchett
- Division of Infectious Diseases, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Bradford Siegele
- Department of Pathology and Laboratory Services, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Olga Weinberg
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Nancy M Rodig
- Division of Nephrology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Rima Fawaz
- Department of Gastroenterology and Hepatology, Yale New Haven Children's Hospital, New Haven, Connecticut, USA
| | - Tajinder P Singh
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Dawn A Freiberger
- Department of Pulmonary and Respiratory Diseases, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Heung Bae Kim
- Department of Surgery, Boston Children's Hospital, Boston, Massachusetts, USA
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