Progressive multifocal leukoencephalopathy after cardiac transplantation

Wa, Hall; Aj, Martínez; Js, Dummer

doi:10.1212/wnl.38.6.995-a

Cited by 17 publications

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“…Six were derived from the non‐English medical literature. A total of 32 patients were reported in detail, including 3 lung,28–30 4 heart,31–34 6 liver,35–40 and 19 kidney4, 41–57 recipients (Fig 2). Among kidney transplants, graft was from a deceased donor (n = 9), living donor (n = 7), combined living and dead donors (n = 1), and unstated (n = 2).…”

Section: Resultsmentioning

confidence: 99%

Progressive multifocal leukoencephalopathy in transplant recipients

Mateen

Muralidharan

Carone

et al. 2011

Annals of Neurology

162

137

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Objective Transplant recipients are at risk of developing progressive multifocal leukoencephalopathy (PML), a rare demyelinating disorder caused by oligodendrocyte destruction by JC virus. Methods Reports of PML following transplantation were found using PubMed Entrez (1958–July 2010). A multicenter, retrospective cohort study also identified all cases of PML among transplant recipients diagnosed at Mayo Clinic, Johns Hopkins University, Washington University, and Amsterdam Academic Medical Center. At 1 institution, the incidence of posttransplantation PML was calculated. Results A total of 69 cases (44 solid organ, 25 bone marrow) of posttransplantation PML were found including 15 from the 4 medical centers and another 54 from the literature. The median time to development of first symptoms of PML following transplantation was longer in solid organ vs bone marrow recipients (27 vs 11 months, p = 0.0005, range of <1 to >240). Median survival following symptom onset was 6.4 months in solid organ vs 19.5 months in bone marrow recipients (p = 0.068). Case fatality was 84% (95% confidence interval [CI], 70.3–92.4%) and survival beyond 1 year was 55.7% (95% CI, 41.2–67.2%). The incidence of PML among heart and/or lung transplant recipients at 1 institution was 1.24 per 1,000 posttransplantation person-years (95% CI, 0.25–3.61). No clear association was found with any 1 immunosuppressant agent. No treatment provided demonstrable therapeutic benefit. Interpretation The risk of PML exists throughout the posttransplantation period. Bone marrow recipients survive longer than solid organ recipients but may have a lower median time to first symptoms of PML. Posttransplantation PML has a higher case fatality and may have a higher incidence than reported in human immunodeficiency virus (HIV) patients on highly-active antiretroviral therapy (HAART) or multiple sclerosis patients treated with natalizumab.

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Section: Resultsmentioning

confidence: 99%

Progressive multifocal leukoencephalopathy in transplant recipients

Mateen

Muralidharan

Carone

et al. 2011

Annals of Neurology

162

137

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“…20, 21 The potential for increasing numbers of cases becomes even more apparent when one considers overall exposure to JC virus: 80% of the general population has serologic evidence of JC virus infection by middle adulthood.22 Thus, it seems likely that PML will be encountered with increased frequency in both general neurology and pathology practice, particularly in areas with a high incidence of HIV infection. Although the growing number of patients infected by HIV represents the most obvious source of new cases, increasing numbers of patients currently undergo profound immunosuppression as a result of treatment for various malignancies and other medical conditions.…”

Section: Discussionmentioning

confidence: 99%

Cytomorphology of progressive multifocal leukoencephalopathy (PML): Review of sixteen cases occurring in HIV‐positive patients

Yu¹,

Hidvegi²,

Cajulis³

et al. 1996

Diagn. Cytopathol.

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“…l9 As this patient population grows with prolonged follow-up, long-term complications of their treatment have begun to appear, including isolated reports of PML. 20, 21 The potential for increasing numbers of cases becomes even more apparent when one considers overall exposure to JC virus: 80% of the general population has serologic evidence of JC virus infection by middle adulthood.22 Thus, it seems likely that PML will be encountered with increased frequency in both general neurology and pathology practice, particularly in areas with a high incidence of HIV infection. As such, its appearance (histologic and cytologic) is one with which pathologists should become familiar.…”

Section: Discussionmentioning

confidence: 99%

Cytomorphology of progressive multifocal leukoencephalopathy (PML): Review of sixteen cases occurring in HIV-positive patients

Hidvegi

Cajulis

et al. 1996

Diagn. Cytopathol.

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Progressive multifocal leukoencephalopathy (PML) is a fatal demyelinating disorder of the central nervous system (CNS) resulting from infection of oligodendrocytes by JC virus. Although all patients immunocompromised by any congenital, acquired, or iatrogenic condition are at risk, the population which currently accounts for the majority of new cases is that infected with the human immunodeficiency virus (HIV). Though the clinical/radiologic presentation is characteristic, biopsy confirmation is necessary, as these patients are at risk for other primary CNS disorders which may produce similar clinical findings. Immediate assessment of tissue adequacy by cytologic smear is generally preferred in these specimens due to its relative reduced risk of disease transmission when compared to conventional frozen section. We report here the cytologic findings seen in touch imprints and squash preparations of 16 cases of PML, all occurring in HIV‐positive patients and obtained by stereotactic guided needle biopsy. Typical cytomorphologic findings are described and correlated with histologic sections. In addition, features useful in the exclusion of other differential diagnostic possibilities are discussed. Diagn Cytopathol 1996;14:4–9. © 1996 Wiley‐Liss, Inc.

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Progressive multifocal leukoencephalopathy after cardiac transplantation

Cited by 17 publications

References 0 publications

Progressive multifocal leukoencephalopathy in transplant recipients

Progressive multifocal leukoencephalopathy in transplant recipients

Cytomorphology of progressive multifocal leukoencephalopathy (PML): Review of sixteen cases occurring in HIV‐positive patients

Cytomorphology of progressive multifocal leukoencephalopathy (PML): Review of sixteen cases occurring in HIV-positive patients

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