Prevention and Preemptive Therapy of Posttransplant Lymphoproliferative Disease in Pediatric Liver Recipients1

Sv, McDiarmid; Jordan, Stanley C.; Gs, Kim; Toyoda, Mieko; Ja, Goss; Vargas, Jorge; Mg, Martín; Bahar, Ron; Al, Maxfield; Me, Ament; Rw, Busuttil

doi:10.1097/00007890-199812270-00006

Cited by 322 publications

(248 citation statements)

References 44 publications

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“…EBV activity can be assessed in a number of ways, including evaluation of EBV viral load in the peripheral blood (as measured by PCR amplification), measurement of the number of EBV-infected peripheral blood mononuclear cells, and ex vivo spontaneous growth of EBV-transformed B cells. [32][33][34][35][36][37] Serology for antibodies to EBV viral capsid antigen or nuclear antigen is less sensitive than these methods, but is more specific for EBV disease; however, these tests are not routinely available in all clinical chemistry labs and thus results may be delayed. By all of these measures, it has been demonstrated that EBV activity is greater in transplant recipients with PTLD than in transplant recipients without PTLD, healthy EBV-seropositive adults, or healthy adults with infectious mononucleosis.…”

Section: Surveillancementioning

confidence: 99%

“…Although the studies were small, negative predictive values (94-100%) and sensitivities (100%) were quite high. 36,37,39 It is interesting to note that EBV DNA levels decrease with anti-EBV therapy, 35,37 although this may not always correlate with the PTLD tumor response. 40 Thus, while measurement of EBV viral load is biologically appealing as a predictive test, the clinical utility remains to be determined.…”

Section: Surveillancementioning

confidence: 99%

See 1 more Smart Citation

Post-transplant lymphoproliferative disorder: a review

Loren

Porter

Stadtmauer

et al. 2003

Bone Marrow Transplant

247

201

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Summary:Post-transplant lymphoproliferative disorder (PTLD) represents a spectrum of Epstein-Barr virus-related (EBV) clinical diseases, from a benign mononucleosis-like illness to a fulminant non-Hodgkin's lymphoma. In the setting of hematopoietic stem cell transplantation, PTLD is an often-fatal complication occurring relatively early after transplant. Risk factors for the development of PTLD are well established, and include HLA-mismatching, T-cell depletion, and the use of antilymphocyte antibodies as conditioning or treatment of graft-versushost disease. Early recognition of PTLD is particularly important in the SCT setting, because PTLD in these patients tends to be rapidly progressive. Familiarity with the clinical features of PTLD and a heightened level of suspicion are critical for making the diagnosis. Surveillance techniques with EBV antibody titers and/or polymerase chain raction (PCR) may have a role in some highrisk settings. Immune-based therapies such as monoclonal anti-B-cell antibodies, interferon-a, and EBV-specific donor T cells, either as treatment for PTLD or as prophylaxis in high-risk patients, represent promising new directions in the treatment of this disease.

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Section: Surveillancementioning

confidence: 99%

Section: Surveillancementioning

confidence: 99%

Post-transplant lymphoproliferative disorder: a review

Loren

Porter

Stadtmauer

et al. 2003

Bone Marrow Transplant

247

201

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“…Bacterial and fungal infections affect up 75% of patients and directly result in up to 50% of deaths. 1,11 Multiresistant organisms, such as methicillin-resistant Staphylococcus aureus, multiresistant Klebsiella, and vancomycin-resistant enterococcus, [25][26][27][28] The immunosuppressive management of neonates is difficult and rarely tailored to age. In most centers, neonates receive regimens similar to those for older patients, with protocols based on either cyclosporine or tacrolimus.…”

Section: Operative and Postoperative Considerationsmentioning

confidence: 99%

Liver transplantation in neonates

Sundaram

Alonso

Whitington

2003

Liver Transplantation

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Orthotopic liver transplantation (OLT) has evolved over the past two decades to become the standard of care for end-stage liver disease in infants and children. Technical advances, particularly the use of technical variant allografts, have permitted extension of OLT into a much younger and smaller population than previously possible. Major centers around the world now routinely perform OLT in infants with survival success equivalent to that in older children and adults. We are beginning to see a small population of school-aged children who were infant OLT recipients. The further extension of OLT into neonates is more recent, with only a few pediatric centers reporting survival success. Very little is known about this frontier of transplantation. Our intent is to provide an overview of neonatal OLT using all available data and our experience in the field. (Liver Transpl 2003;9:783-788.)F or the purpose of this review, neonatal orthotopic liver transplantation (OLT) is defined as transplantation performed in the first three months of life. This does not coincide with the usual definition of the neonate, infants in their first month of life. The extension to three months is necessary, however, because of the manner in which data regarding pediatric OLT have been collated. This division also holds because most diseases necessitating neonatal OLT produce liver failure at or near the time of birth. United Network for Organ Sharing (UNOS) data show that in 2001, 623 pediatric OLTs were performed in the United States. Of these transplantations, 167 were performed in children younger than one year of age and only eight in neonates. The number of neonatal OLT procedures has been varied over the past four years from eight to 14, with the peak in 2000. Patient and graft survival, 57% and 38% respectively, remain significantly lower than that of older children. 1,2 UNOS data show that infants three to 12 months old have graft and patient survival of 72.8 % and 82.1%, respectively. Children aged one to five years have 76.8% graft and 84.1% patient survival, and those older than six years have greater than 82% graft and 91% patient survival. These data demonstrate that transplantation in neonates presents unique medical and technical challenges. The complexities of liver transplantation in this age group have received relatively little attention in the medical literature. This review details the common indications for transplantation, addresses the multiple obstacles to successful transplantation, and explores strategies to improve survival and long-term outcomes in neonatal recipients. Defining the ProblemThe age distribution of reported neonatal OLTs is evenly distributed across the first three months of life. Woodle et al reported a series of 23 neonatal OLTs performed at three US centers: 28% were less than one month old, 35% were one to two months old, and 36% were two to three months old at the time of transplantation. 2 The youngest infant reported to undergo liver transplant was five days old. 3 The typical body weight...

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“…1, EBER-1, LMP have been used to identify patients at risk for PTLD, especially in the pediatric and allogeneic bone marrow transplant populations (11)(12)(13)(14)(15)(16). These two patient populations are particularly at high risk for PTLD, given the lack of EBV immunity in most pediatric patients and the high level of immunosuppression and the altered immune system seen in T-cell depleted or mismatched allogeneic bone marrow transplants.…”

Section: Ebv Pcr For Diagnosis and Monitoring Of Ptldmentioning

confidence: 99%