Risk Factors for Posttransplant Lymphoproliferative Disorder (Ptld) in Pediatric Kidney Transplantation: A Report of the North American Pediatric Renal Transplant Cooperative Study (Naprtcs)1

Dharnidharka, Vikas R.; Sullivan, Emily; Stablein, Donald M.; Tejani, Amir; Harmon, William

doi:10.1097/00007890-200104270-00010

Cited by 217 publications

(162 citation statements)

References 14 publications

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“…The variation in reported incidence rates is partly because of differences in the types of organ transplanted, immune suppressive therapy [9], period of observation [10], and patient demographics [2]. Registry-based studies [2,[10][11][12][13][14][15] are especially helpful in evaluating the risk factors for PTLD development, but do not usually provide detailed information about the treatment and outcomes of those with PTLD. In the present study, which represents a single center's experience with this disease, an overall risk of 1.2% was found, identical to the estimates from a much larger and inclusive, registry-based study [2] in which the estimates reflected the total burden of PTLD among participants of the United Network of Organ Sharing.…”

Section: Discussionmentioning

confidence: 99%

Treatment and outcomes of post‐transplant lymphoproliferative disease: A single institution study

et al. 2006

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Post-transplant lymphoproliferative disorders (PTLD) complicate up to 10% of solid organ transplants. This retrospective study was conducted to review the PTLD experience among 2,300 recipients of solid organ or allogeneic bone marrow transplants from a single institution. Twenty-seven cases of PTLD were identified, leading to an overall incidence of 1.2%. Polymorphic B cell hyperplasia/lymphoma was the most common type. The median time to development of PTLD was 8.4 months. Ten patients had localized (stage I or II) disease, and 12 patients presented with B symptoms. Nine patients each were treated with systemic chemotherapy or surgical resection as part of the initial therapy. After a median follow-up duration of 2.6 years, the median survival has not been reached. There were no late relapses of PTLD, and 17 patients remain alive. Age, sex, organ source, LDH, stage, presence of extranodal disease, or presentation with B symptoms did not influence overall survival when examined by Cox proportional hazard model. Thirteen patients retained their graft function throughout PTLD treatment. This study confirms the ability to treat a significant proportion of PTLD patients with chemotherapy or surgical resection (depending on presentation), without sacrificing graft function in those receiving chemotherapy. Am. J. Hematol. 82:208-214, 2007. V V C 2006 Wiley-Liss, Inc.

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Section: Discussionmentioning

confidence: 99%

Treatment and outcomes of post‐transplant lymphoproliferative disease: A single institution study

et al. 2006

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“…In other large series, CYA treatment did not enhance the risk for lymphoma compared with azathioprine (AZA) therapy (6,8,9). Experience with FK506-based immunosuppression is limited, although an increase in lymphomas has been described among pediatric patients (10,11). A heightened risk for lymphoma has also been reported among patients receiving induction therapy with OKT3, especially beyond a threshold cumulative dose (6,9,12).…”

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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“…In this study young, Caucasian and EBV mismatched children were more likely and African-American children were less likely to develop PVL. These demographic and clinical characteristics have been identified as risk factors for PTLD in the previous studies; however, these characteristics have not been previously assessed for development of EB PVL [1,[8][9][10]. Concern has been raised that thymoglobulin may play a role in the development of PTLD as it has been shown to deplete poly functional T cells in HIV infected kidney transplant recipients and activate EBV replication [11].…”

Section: Discussionmentioning

confidence: 99%

“…Post-transplant lymphoproliferative disorder (PTLD) is a serious complication in Epstein Barr virus (EBV) naïve children [1]. Most cases of PTLD are EBV driven and have evidence of EBV infection at diagnosis [2].…”

Section: Introductionmentioning

confidence: 99%

Significance of Asymptomatic Persistent Epstein-Barr Viral Load in Pediatric Renal Transplant Recipients: North American Pediatric Renal Trials and Collaborative Studies Report

Moudgil¹,

Martz²,

Moore³

et al. 2014

TOUNJ

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Methods: NAPRTCS centers invited to enter data on children with asymptomatic PVL (≥ 6 months) into the EB VL registry. Comparison group included children into the NAPRTCS TX arm during the same period without PVL or VL monitoring. EB VL were arbitrarily divided into low (1-10), medium (>10-100) and high (>100times detection limit for the center) ratio.Results: Of 645 children (18 centers), 85 (13.2%) developed onset of PVL at a mean of 6.4 ± 6.3 months post-TX. PVL children were more likely to be younger (< 5 years) at TX and less likely to be African-American and majority (75.3%) was mismatched for EBV (donor EBV IgG positive and recipient negative). Thymoglobulin induction was used in 29.4% children with PVL versus 37% in controls (p=ns). PTLD developed in 7/85 (8.2%) children with PVL versus 5/560 (0.9%) controls (p < 0.0001). EB VL ratios were not different in those with and without PTLD. EB PVL as time varying covariate did not affect patient survival, GF and AR (HR, 0.85, 0.53 and 0.99). The change in GFR overtime in children with PVL was comparable to controls. Conclusion:Children with PVL (actual load not predictive) are at increased risk for PTLD, but not for AR, death, GF or loss of graft function.

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Risk Factors for Posttransplant Lymphoproliferative Disorder (Ptld) in Pediatric Kidney Transplantation: A Report of the North American Pediatric Renal Transplant Cooperative Study (Naprtcs)1

Abstract: There is a trend towards increasing incidence and earlier occurrence of PTLD in the pediatric renal transplant population. White race and cadaver donor sources are risk factors not reported before. Continued monitoring of tacrolimus immunosuppression is important.

Cited by 217 publications

References 14 publications

Treatment and outcomes of post‐transplant lymphoproliferative disease: A single institution study

Treatment and outcomes of post‐transplant lymphoproliferative disease: A single institution study

Lymphomas After Solid Organ Transplantation: A Collaborative Transplant Study Report

Significance of Asymptomatic Persistent Epstein-Barr Viral Load in Pediatric Renal Transplant Recipients: North American Pediatric Renal Trials and Collaborative Studies Report

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