A single-center experience of post-transplant lymphoproliferative disorder (PTLD) cases after pediatric liver transplantation: Incidence, outcomes, and association with food allergy

Barış, Zeren; Özçay, Figen; Özbek, Özlem; Haberal, Nihan; Sarıalıoğlu, Faık; Haberal, Mehmet

doi:10.5152/tjg.2018.17731

Cited by 15 publications

(11 citation statements)

References 17 publications

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“…Haung et al (20) reported a mean age of 4.1 years at the time of transplantation. In another study by Barış et al, the mean age at transplantation was 2.71 ± 3.21 years, and low age at transplantation, especially ages < 2.5 years, was considered a risk factor for the occurrence of PTLD (21). These results were consistent with those of the present investigation.…”

Section: Discussionsupporting

confidence: 93%

Post-transplant Lymphoproliferative Disorder in Pediatric Liver Transplantation: A Population-based Study from Shiraz, Iran

et al. 2021

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Background: This study aimed to determine the prevalence of post-transplant lymphoproliferative disorder (PTLD) based on the clinical and epidemiological characteristics of donors and pediatric transplant recipients. Methods: This cross-sectional study was conducted on the patients who had experienced liver transplantation at Shiraz Transplant Center, Shiraz, Iran, from April 2007 to March 2017. Data on the epidemiological characteristics, underlying diseases, dosage of immunosuppressive drugs, and duration of drug consumption from the time of liver transplantation until the onset of PTLD for transplant recipients, and donors’ age, sex, and family relationship with recipients were collected using a data-gathering form. Log rank test was employed to determine the variations in the distribution of survival in different sex and age groups. Results: The study findings indicated that 49 out of the 1207 children who had undergone liver transplantation developed PTLD, revealing a prevalence of 4%. The results showed no significant relationship between gender and the incidence of PTLD (P = 0.13). However, the mean age of the cases with PTLD was 4.93 ± 1.07 years at the time of transplantation, while non-PTLD patients showed a higher mean age at that time (7.80 ± 5.54). The mean dose of the immunosuppressive drugs (dose/kg) consumed by the recipients was as follows: tacrolimus = 0.2753 ± 0.23435, prednisolone = 0.6761 ± 0.62218, cellcept = 0.0724 ± 0.12963, and sirolimus = 0.1078 ± 0.08813. The average consumption period of the above-mentioned drugs from the time of transplantation until the onset of PTLD was 14.7 ± 14.409 months. Based on the results, the five-year survival rate was much lower in the patients with PTLD compared to the non-PTLD patients (31% Vs. 72.7%). The survival distribution was significantly different based on sex and age groups (P = 0.59 and P = 0.06, respectively). Conclusions: The prevalence of the clinical and epidemiological features of the PTLD in the patients under the present investigation was similar to those of the patients in other hospitals. Recognizing the clinical and epidemiological characteristics of transplant recipients with and without PTLD and donors can provide a basis for managing these patients.

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Section: Discussionsupporting

confidence: 93%

Post-transplant Lymphoproliferative Disorder in Pediatric Liver Transplantation: A Population-based Study from Shiraz, Iran

et al. 2021

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“…Patients who were transplanted at an early age and EBV-naive may also contribute to high incidence. 8 Patients with non-B-cell malignancy had a poorer prognosis than those with B-cell-type malignancy. 9 In our tive immunosuppression modulation and a general reduction in the overall level of immunosuppression.…”

Section: Discussionmentioning

confidence: 99%

“…This high EBV‐positive incidence is, in part, due to the capacity for immunosuppressants to inhibit cytotoxic T cells which results in an uncontrolled proliferation of B cells activated by EBV infection. Patients who were transplanted at an early age and EBV‐naive may also contribute to high incidence 8 . Patients with non–B‐cell malignancy had a poorer prognosis than those with B‐cell‐type malignancy 9 .…”

Section: Discussionmentioning

confidence: 99%

Post‐transplant lymphoproliferative disorder after paediatric liver transplantation

et al. 2020

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Objective The purpose of this study was to analyse the clinical and pathological characteristics, treatments and outcomes of post‐transplant lymphoproliferative disorder (PTLD) in paediatric liver transplant recipients. Method A retrospective analysis of records from nine paediatric liver transplant recipients with PTLD who were treated at our Liver Transplant Center over the period from June 2013 to August 2018. Result Of these nine patients, seven received liver transplantation in our centre and the remaining two patients at other hospitals. The overall incidence of PTLD in paediatric liver transplant recipients in our centre was 1.4% (7/485). The median onset of PTLD after liver transplantation was 11 months. Three cases were classified as infectious mononucleosis PTLD, one case was plasmacytic hyperplasia PTLD, one case was polymorphic PTLD and two cases were Burkitt lymphoma. One case showed diffuse large B‐cell lymphoma and one was classical Hodgkin lymphoma‐like PTLD. These patients presented with different clinical manifestations including fever, anaemia, diarrhoea, hypoproteinaemia, enlargement of lymph nodes, hepatosplenomegaly, jaundice, bowel obstruction and even intestinal perforation. Nine patients were positive for EBV‐DNA in serum. After diagnosis, immunosuppressants were reduced or discontinued in all cases. Eight patients received anti‐CD20 monoclonal antibody (Rituximab) therapy, four cases were treated with a combination of chemotherapy (R‐CHOP, ABVD, COPP/ABV) and one case was combined with radiotherapy. Two cases received surgical treatment due to bowel obstruction. Eight of these patients achieved a complete remission and remained healthy when assessed at the time of final follow‐up. One patient died as a result of PTLD progression. Conclusion PTLD is one of the most serious and fatal complications after liver transplantation. The definitive diagnosis requires histopathology. Treatment varies and basically includes immunosuppression reduction, anti‐CD20 antibody, surgery, radiotherapy and chemotherapy.

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“…Since then, only a few studies have discussed the issue. We performed a review of such studies in the English literature and have listed those discussing nasopharyngeal PTLDs in Table 1 to compare the demographic characteristic, histopathological features, types of organ transplantation, clinical manifestations, therapeutic methods, time to PTLD of nasopharynx development after transplantation, and prognosis after treatment [ 1 , 7 , 8 , 9 , 10 , 11 ]. In general, compared with early lesions of the nasopharyngeal PTLD, polymorphic, monomorphic, and classic Hodgkin lymphoma PTLD have more aggressive courses and worse prognoses.…”

Section: Discussionmentioning

confidence: 99%

Malignant Post-Transplant Lymphoproliferative Disorder of Nasopharynx in Myelodysplastic Disorder

et al. 2021

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(1) Background: Post-transplant lymphoproliferative disorder (PTLD) is a hematological disease and occurs because of immunosuppression after organ transplantation. Only a few studies have reported PTLD in the nasopharynx. In most cases, PTLD developed after solid organ transplantation, and cases of PTLD after bone marrow transplantation, are uncommon. (2) Case presentation: We report the case of a 40-year-old woman with myelodysplastic disorder who underwent hematopoietic stem cell transplantation (HSCT). After 3 months, she developed low-grade fever, progressive nasal obstruction, and bloody rhinorrhea. Endoscopy revealed a mass completely occupying the nasopharynx. A polymorphic PTLD was diagnosed on the basis of histopathological examination results. Reduction in immunosuppression and low-dose radiotherapy were prescribed for treatment. After a 3-year follow-up, no recurrence of PTLD or myelodysplastic disorder was detected. (3) Conclusions: While nasopharyngeal PTLD is rare, a routine examination of the nasopharynx should be considered in the post-transplant follow-up of patients for early detection and treatment of PTLD.

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A single-center experience of post-transplant lymphoproliferative disorder (PTLD) cases after pediatric liver transplantation: Incidence, outcomes, and association with food allergy

Cited by 15 publications

References 17 publications

Post-transplant Lymphoproliferative Disorder in Pediatric Liver Transplantation: A Population-based Study from Shiraz, Iran

Post-transplant Lymphoproliferative Disorder in Pediatric Liver Transplantation: A Population-based Study from Shiraz, Iran

Post‐transplant lymphoproliferative disorder after paediatric liver transplantation

Malignant Post-Transplant Lymphoproliferative Disorder of Nasopharynx in Myelodysplastic Disorder

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