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Transplantation. 2019 Aug 1. doi: 10.1097/TP.0000000000002898. [Epub ahead of print]

Posttransplant Lymphoproliferative Disorder in Pediatric Patients: Characteristics of Disease in EBV-seropositive Recipients.

L'Huillier AG1, Dipchand AI2,3,4, Ng VL2,3,5, Hebert D2,3,6, Avitzur Y2,3,5, Solomon M2,3,7, Ngan BY2,8, Yeung S1, Stephens D2,9, Punnett AS2,10, Barton M1,3,11, Allen UD1,2,3.

Author information

1
Division of Infectious Diseases, Hospital for Sick Children, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada.
2
University of Toronto, 27 King's College Circle, Toronto, Ontario M5S 1A1, Canada.
3
Transplant and Regenerative Medicine Centre, Hospital for Sick Children, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada.
4
Labatt Family Heart Centre, Hospital for Sick Children, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada.
5
Division of Pediatric Gastroenterology, Hepatology and Nutrition, Hospital for Sick Children, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada.
6
Division of Nephrology, Hospital for Sick Children, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada.
7
Division of Respiratory Medicine, Hospital for Sick Children, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada.
8
Division of Pathology, Hospital for Sick Children, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada.
9
The Research Institute, Hospital for Sick Children, Toronto, Ontario.
10
Division of Haematology/Oncology, Hospital for Sick Children, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada.
11
Division of Infectious Diseases, London Health Sciences Centre, University of Western Ontario, 800 Commissioners Rd E, London, N6A 5W9, Ontario, Canada.

Abstract

BACKGROUND:

Patients at greatest risk of posttransplant lymphoproliferative disorder (PTLD) are those who acquire primary EBV infection after solid organ transplantation (SOT). The incidence of PTLD among patients who are EBV-seropositive prior to transplant is lower and little is known about the differences in presentation and outcome of this population. We describe the characteristics of EBV-seropositive transplant recipients (R+) who developed PTLD and compare survival outcomes with EBV-seronegative recipients (R-).

METHODS:

A hospital-based registry was used to identify all patients with biopsy-proved PTLD for the period 2000-2014. Characteristics and outcomes were compared between R+ and R- patients with PTLD.

RESULTS:

Sixty-nine patients were included, among which 20 (29.0%) were R+ and 49 (71.0%) were R-. Multi-organ transplant patients accounted for 25% of PTLD cases in R+ patients, while accounting for only 2.1% of all transplants during the study period. There was no difference in PTLD site between R+ and R- patients.PTLD among R+ individuals occurred during the second year after transplant (median 1.92, range 0.35-3.09 years) compared with during the first year for R- individuals (median 0.95, range 0.48-2.92 years; P=0.380).There was a trend for a higher overall mortality among R+ individuals (log-rank 0.09). PTLD-related mortality did not differ between R+ and R- individuals (log-rank 0.17).

CONCLUSION:

PTLD among R+ individuals was more likely to occur among multi-organ recipients and there was a tendency for poorer outcomes at 1 and 5 years after the diagnosis of PTLD.

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