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

Abstract

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.

Post‐transplant lymphoproliferative disorder in pediatric liver transplant recipients: Experience from a South African transplant center

“…Most pediatric patients were found to be EBV seronegative at transplant predisposing them to develop PTLD especially when related living donor liver transplants are performed, as was found in more than half of the children in our cohort. Studies done by Imanieh 31 et al. and Mynarek 32 et al.…”

“…Most pediatric patients were found to be EBV seronegative at transplant predisposing them to develop PTLD especially when related living donor liver transplants are performed, as was found in more than half of the children in our cohort. Studies done by Imanieh 31 The mortality rate from PTLD in PLT recipients is low and has also decreased with time over the years. This is likely due to improved surveillance with regular EBV viral load monitoring and the adoption in most transplant units of decreasing immunosuppression doses secondary to rising EBV viral loads.…”