Post-transplant lymphoproliferative disorders and other malignancies after pediatric intestinal transplantation: incidence, clinical features and outcome

Pediatr Transplant. 2013 Aug;17(5):472-8. doi: 10.1111/petr.12103. Epub 2013 Jun 4.

Abstract

PTLDs are a well-recognized and potentially fatal complication after intestinal transplantation. We analyzed the incidence, clinical features, and outcome in a 63 intestinal transplantation series performed in our unit between October 1999 and July 2011. Types of graft included ISB (n = 23), LSB (n = 20), and MV (n = 20). Patients were categorized into three groups of immunosuppression: I (n = 43) received basiliximab, tacrolimus, and steroids; II (n = 11) thymoglobulin and tacrolimus, and III (n = 9) alemtuzumab and tacrolimus. EBV status was serially assessed. All PTLD cases were biopsied to establish histopathological diagnosis. The incidence of PTLD was 14.2% (9/63). Median onset of PTLD after transplant was four months (range: 0.5-28), within first postoperative year in 6 (66.6%) patients. Fever was the most common symptom. Graft removal was needed in four patients (44%). The patient survival rate was 66.6% (6/9). We have not found any association between PTLD and immunosuppression regimen or transplant type. However, there was a statistical association with EBV active infection.

Keywords: Epstein-Barr virus; immunosuppression; intestinal transplantation; post-transplant lymphoproliferative.

MeSH terms

  • Alemtuzumab
  • Antibodies, Monoclonal / therapeutic use
  • Antibodies, Monoclonal, Humanized / therapeutic use
  • Antilymphocyte Serum / therapeutic use
  • Basiliximab
  • Child, Preschool
  • Epstein-Barr Virus Infections / complications
  • Female
  • Humans
  • Immunosuppression Therapy / adverse effects*
  • Immunosuppression Therapy / methods
  • Immunosuppressive Agents / therapeutic use
  • Incidence
  • Infant
  • Intestines / transplantation*
  • Lymphoproliferative Disorders / epidemiology
  • Lymphoproliferative Disorders / etiology*
  • Lymphoproliferative Disorders / therapy*
  • Male
  • Postoperative Complications
  • Postoperative Period
  • Recombinant Fusion Proteins / therapeutic use
  • Retrospective Studies
  • Steroids / therapeutic use
  • Tacrolimus / therapeutic use
  • Transplantation / adverse effects*
  • Treatment Outcome

Substances

  • Antibodies, Monoclonal
  • Antibodies, Monoclonal, Humanized
  • Antilymphocyte Serum
  • Immunosuppressive Agents
  • Recombinant Fusion Proteins
  • Steroids
  • Alemtuzumab
  • Basiliximab
  • thymoglobulin
  • Tacrolimus