Posttransplantation Lymphoproliferative Disorder: Manifestations in Pediatric Thoracic Organ Recipients

Lim, Gio‐Bin; Newman, Beverley; Kurland, Geoffrey; Webber, Steven A.

doi:10.1148/radiol.2223010456

Cited by 39 publications

(38 citation statements)

References 27 publications

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“…It has been suggested that continuing immunostimulation by the transplanted organ may also be involved in lymphoma formation (17). In support of this hypothesis is the finding of a significant association between the location of the transplant and the distribution of the lymphoma (6,18,19).…”

Section: Introductionmentioning

confidence: 94%

Lymphomas After Solid Organ Transplantation: A Collaborative Transplant Study Report

Opelz

Döhler

2004

American Journal of Transplantation

977

787

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We used the Collaborative Transplant Study database to analyze the incidence, risk, and impact of malignant lymphomas in approximately 200 000 organ transplant recipients. Over a 10-year period, the risk in renal transplant recipients was 11.8-fold higher than that in a matched nontransplanted population (p < < 0.0001). The majority of lymphomas were diagnosed after the first post-transplant year. Heart-lung transplants showed the highest relative risk (RR 239.5) among different types of organ transplants. In kidney recipients, immunosuppression with cyclosporine did not confer added risk compared with azathioprine/steroid treatment, whereas treatment with FK506 increased the risk approximately twofold. Induction therapy with OKT3 or ATG, but not with anti-IL2 receptor antibodies, increased the risk of lymphoma during the first year. Antirejection therapy with OKT3 or ATG also increased the risk. First-year mortality in renal and heart transplant patients with lymphoma was approximately 40% and 50%, respectively, and showed no improvement in recent years. A pattern of preferential localization to the vicinity of the transplant was noted, and the prognosis of the patient was related to localization. This study highlights the continuing risk for lymphoma with time post-transplantation, the contribution of immunosuppression to increased risk, and continuing poor outcomes in patients with post-transplant lymphoma.

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Section: Introductionmentioning

confidence: 94%

Lymphomas After Solid Organ Transplantation: A Collaborative Transplant Study Report

Opelz

Döhler

2004

American Journal of Transplantation

977

787

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“…PTLD is a potentially fatal condition manifested by an abnormal expansion of lymphocytic cells [4][5][6][7][8][9][10] . It may have a variable distribution, affecting several organs and tissues.…”

Section: Discussionmentioning

confidence: 99%

“…Immunosuppressive therapy that transplanted patients have to undergo in order to prevent organ rejection exposes them to a high risk of developing neoplasms, mainly posttransplantation lymphoproliferative disorders (PTLD) [2][3][4][5][6][7] . The exact incidence of PTLD is unknown, ranging from 2% to 20%; however it is known to be higher among children 5,8 .…”

mentioning

confidence: 99%

“…The exact incidence of PTLD is unknown, ranging from 2% to 20%; however it is known to be higher among children 5,8 .…”

mentioning

confidence: 99%

“…Therefore, post-transplantation seroconversion is a significant risk factor for the development of PTLD 5,9,10 . Of the pediatric patients who seroconvert after heart transplantation, approximately 63% develop PTLD 9 .…”

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confidence: 99%

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Desordem linfoproliferativa pós-transplante em paciente pediátrico

Pêgo-Fernandes¹,

Azeka²,

Odoni³

et al. 2006

Arq. Bras. Cardiol.

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Immunosuppressive therapy for transplanted patients exposes them to a high risk of developing posttransplantation lymphoproliferative disorders (PTLD). We report the case of a child undergoing heart transplantation at seven months of age who developed PTLD at nine years of age, diagnosed by resection of a pulmonary nodule. In the past few years, because of the improved preservation of donated organs and of the larger experience with immunosuppressive therapy, a significant increase in the survival of children after heart transplantation has been observed. Thus, transplantation has become a broadly accepted therapeutic option for children and adolescents with congenital heart defects or cardiomyopathies in advanced stages 1-3 .Immunosuppressive therapy that transplanted patients have to undergo in order to prevent organ rejection exposes them to a high risk of developing neoplasms, mainly posttransplantation lymphoproliferative disorders (PTLD) 2-7 . The exact incidence of PTLD is unknown, ranging from 2% to 20%; however it is known to be higher among children 5,8 .A higher frequency of PTLD is observed among children because the great majority of them had not been exposed to the Epstein-Barr virus (EBV) prior to heart transplantation. Therefore, post-transplantation seroconversion is a significant risk factor for the development of PTLD 5,9,10 . Of the pediatric patients who seroconvert after heart transplantation, approximately 63% develop PTLD 9 .The EBV is believed to play a key role in the pathogenesis of PTLD 4 . This virus is able to enter B cells and induce their proliferation, which is normally controlled by many immune mechanisms such as proliferation and activation of cytotoxic T lymphocytes. Anti-rejection immunosuppressive drugs inhibit the response of these cytotoxic T lymphocytes, which results in the proliferation of B cells induced by EBV 7 .Treatment modalities for PTLD are varied and include reduction of the immunosuppressive therapy, control of EBV replication, conventional antineoplastic therapy (radiotherapy, chemotherapy, and surgery) and immunotherapy 8 . However, mortality rates are quite significant, varying according to prognostic factors and the treatment chosen 8,10 .The purpose of this publication is to report the case of a child undergoing heart transplantation at seven months of age who developed PTLD eight years and nine months later, diagnosed by resection of a pulmonary nodule. Case ReportMale, nine years old, male, who underwent heart transplantation at seven months of age because of dilated cardiomyopathy.In 2000, he had a respiratory disorder characterized by persistent cough with yellowish sputum, and was diagnosed with bronchopneumonia. He was initially treated with amoxicillin for fourteen days, and cefepime for thirteen days. In 2001, a control chest computed tomography (CT) revealed perihilar lymph nodes and solid masses within the lungs with a progressive evolution, suggestive of an infectious and secondarily tumoral disorder, and the patient was hospitalized for invest...

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Pediatric Lung Transplantation

and

Sweet

2014

Textbook of Organ Transplantation

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Posttransplantation Lymphoproliferative Disorder: Manifestations in Pediatric Thoracic Organ Recipients

Abstract: PTLD in young thoracic transplant recipients involves the lungs and extrathoracic organs, tends to have an early onset, and manifests predominantly in the thorax in lung transplant and heart-lung transplant recipients, as opposed to heart transplant recipients.

Cited by 39 publications

References 27 publications

Lymphomas After Solid Organ Transplantation: A Collaborative Transplant Study Report

Lymphomas After Solid Organ Transplantation: A Collaborative Transplant Study Report

Desordem linfoproliferativa pós-transplante em paciente pediátrico

Pediatric Lung Transplantation

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