Posttransplant Lymphoproliferative Disorder in Pediatric Liver Transplantation: Samsung Medical Center Experience.
- Author:
Yon Ho CHOE
1
;
Suk Koo LEE
;
Jeong Meen SEO
;
Jae Won JOH
;
Sung Joo KIM
;
Kwang Woong LEE
;
Je Hoon PARK
;
Young Hye KO
;
Ki Young KWON
Author Information
1. Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
- Publication Type:Original Article
- Keywords:
Posttransplant lymphoproliferative disorder;
Pediatric liver transplantation;
Epstein-Barr virus infection;
Immunosuppression;
Hypoalbuminemia;
Anemia;
Gastrointestinal bleeding
- MeSH:
Anemia;
Anorexia;
Diagnosis;
Diarrhea;
Epstein-Barr Virus Infections;
Fever;
Hemorrhage;
Herpesvirus 4, Human;
Humans;
Hypoalbuminemia;
Immunosuppression;
Incidence;
Liver Transplantation*;
Liver*;
Lymphoproliferative Disorders*;
Postoperative Period;
Retrospective Studies;
Tissue Donors;
Transplants
- From:Korean Journal of Pediatric Gastroenterology and Nutrition
2003;6(1):39-46
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
PURPOSE: In a retrospective study for the pediatric patients who underwent liver transplantation in the past 6 years at Samsung Medical Center, the clinical features of 5 patients with posttransplant lymphoproliferative disorder (PTLD) were analyzed. METHODS: Between June 1996 and June 2002, 41 pediatric patients underwent liver transplantation. Seven of them died in the postoperative period. Thirty-five including one patient who died of PTLD were finally reviewed. Patients were divided into two groups: high risk group, EBV naive recipients of EBV-positive grafts; low risk group, the patients other than those in high risk group. The authors reviewed age at operation, immunosuppressive agent, postoperative duration until diagnosis, postoperative duration until EBV seroconversion, presence of treatment against rejection, and presenting symptoms of PTLD. RESULTS: Five of 41 patients (12.2%) developed PTLD. All of them belonged to high risk group, and the incidence of PTLD in high risk group was 31.3% (5/16). The mean age at operation was 10.8 months old and the mean duration between operation and diagnosis for PTLD was 9.8 months. Primary EBV infection developed after a median of 6 months after transplantation. One patient was diagnosed as laryngeal and gastrointestinal PTLD and the other four, gastrointestinal PTLD. The following symptoms and signs were seen in the patients: anemia (100%), hypoalbuminemia (100%), fever (80%), diarrhea (80%), gastrointestinal bleeding (80%), and anorexia (60%). CONCLUSION: PTLD is one of the major complications after pediatric liver transplantation, especially in the group of high-risk recipients. Anemia, hypoalbuminemia, fever, diarrhea and gastrointestinal bleeding were features that are characteristic of PTLD. The common features of PTLD development were: (i) EBV-positive donors placed into EBV naive recipients, (ii) primary EBV infection about 6 months after transplantation, (iii) young age, about 1 year old at operation, and (iv) the requirement for intensive posttransplant immunosuppression.
