The changing face of post-transplant lymphoproliferative disease in the era of molecular EBV monitoring

Nanda Kerkar, Raffaella A. Morotti, Rebecca P. Madan, Benjamin Shneider, Betsy C. Herold, Christina Dugan, Tamir Miloh, Ilhan Karabicak, James A. Strauchen, Sukru Emre

Research output: Contribution to journalArticle

33 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)504-511
Number of pages8
JournalPediatric Transplantation
Volume14
Issue number4
DOIs
StatePublished - Jun 2010

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Keywords

  • Epstein-Barr virus
  • Histology
  • Immunosuppression
  • Liver transplantation
  • Lymphoproliferative disease
  • Outcome

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Transplantation

Cite this

Kerkar, N., Morotti, R. A., Madan, R. P., Shneider, B., Herold, B. C., Dugan, C., Miloh, T., Karabicak, I., Strauchen, J. A., & Emre, S. (2010). The changing face of post-transplant lymphoproliferative disease in the era of molecular EBV monitoring. Pediatric Transplantation, 14(4), 504-511. https://doi.org/10.1111/j.1399-3046.2009.01258.x