TY - JOUR
T1 - The changing face of post-transplant lymphoproliferative disease in the era of molecular EBV monitoring
AU - Kerkar, Nanda
AU - Morotti, Raffaella A.
AU - Madan, Rebecca P.
AU - Shneider, Benjamin
AU - Herold, Betsy C.
AU - Dugan, Christina
AU - Miloh, Tamir
AU - Karabicak, Ilhan
AU - Strauchen, James A.
AU - Emre, Sukru
PY - 2010/6
Y1 - 2010/6
N2 - Pediatric PTLD is often associated with primary EBV infection and immunosuppression. The aim was to retrospectively review the spectrum of histologically documented PTLD for two time intervals differentiated by changes in use of molecular EBV monitoring. Eleven of 146 patients (7.5%) in 2001-2005 (Era A) and 10 of 92 (10.9%) in 1993-1997 (Era B) were diagnosed with PTLD. The median age at liver transplantation (0.8 and 0.9 yr, respectively) and the median duration between liver transplant and diagnosis of PTLD (0.6 and 0.7 yr, respectively) were similar in both eras. However, patients in Era A presented with significantly less advanced histological disease compared to patients in Era B (p = 0.03). Specifically, nine patients (82%) in Era A had Pl hyperplasia/polymorphic PTLD, whereas in Era B, six had advanced histological disease (five monomorphic and one unclassified). Three transplant recipients in Era B died secondary to PTLD, whereas there were no PTLD-related deaths in Era A (p = 0.03). Heightened awareness of risk for PTLD, alterations in baseline immunosuppression regimens, implementation of molecular EBV monitoring, pre-emptive reduction in immunosuppression and improved therapeutic options may have all contributed to a milder PTLD phenotype and improved clinical outcomes.
AB - Pediatric PTLD is often associated with primary EBV infection and immunosuppression. The aim was to retrospectively review the spectrum of histologically documented PTLD for two time intervals differentiated by changes in use of molecular EBV monitoring. Eleven of 146 patients (7.5%) in 2001-2005 (Era A) and 10 of 92 (10.9%) in 1993-1997 (Era B) were diagnosed with PTLD. The median age at liver transplantation (0.8 and 0.9 yr, respectively) and the median duration between liver transplant and diagnosis of PTLD (0.6 and 0.7 yr, respectively) were similar in both eras. However, patients in Era A presented with significantly less advanced histological disease compared to patients in Era B (p = 0.03). Specifically, nine patients (82%) in Era A had Pl hyperplasia/polymorphic PTLD, whereas in Era B, six had advanced histological disease (five monomorphic and one unclassified). Three transplant recipients in Era B died secondary to PTLD, whereas there were no PTLD-related deaths in Era A (p = 0.03). Heightened awareness of risk for PTLD, alterations in baseline immunosuppression regimens, implementation of molecular EBV monitoring, pre-emptive reduction in immunosuppression and improved therapeutic options may have all contributed to a milder PTLD phenotype and improved clinical outcomes.
KW - Epstein-Barr virus
KW - Histology
KW - Immunosuppression
KW - Liver transplantation
KW - Lymphoproliferative disease
KW - Outcome
UR - http://www.scopus.com/inward/record.url?scp=77952262867&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=77952262867&partnerID=8YFLogxK
U2 - 10.1111/j.1399-3046.2009.01258.x
DO - 10.1111/j.1399-3046.2009.01258.x
M3 - Article
C2 - 20070559
AN - SCOPUS:77952262867
SN - 1397-3142
VL - 14
SP - 504
EP - 511
JO - Pediatric Transplantation
JF - Pediatric Transplantation
IS - 4
ER -