Post-Transplant Lymphoproliferative Diseases in Pediatric Kidney Allograft Recipients with Epstein-Barr Virus Viremia
10.3346/jkms.2019.34.e203
- Author:
Hyesun HYUN
1
;
Eujin PARK
;
Myunghyun CHO
;
Sang Il MIN
;
Jongwon HA
;
Hyoung Jin KANG
;
Hee Young SHIN
;
Il Soo HA
;
Hae Il CHEONG
;
Yo Han AHN
;
Hee Gyung KANG
Author Information
1. Department of Pediatrics, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
- Publication Type:Original Article
- Keywords:
Post-Transplant Lymphoproliferative Disease;
Kidney Transplantation;
Epstein-Barr Virus;
Rituximab
- MeSH:
Allografts;
Child;
Diagnosis;
Follow-Up Studies;
Herpesvirus 4, Human;
Humans;
Incidence;
Kidney Transplantation;
Kidney;
Neutropenia;
Organ Transplantation;
Retrospective Studies;
Risk Factors;
Rituximab;
Tacrolimus;
Tissue Donors;
Transplants;
Viral Load;
Viremia
- From:Journal of Korean Medical Science
2019;34(30):e203-
- CountryRepublic of Korea
- Language:English
-
Abstract:
BACKGROUND: Post-transplant lymphoproliferative disease (PTLD) is one of the major complications of organ transplantation, especially in children with Epstein-Barr virus (EBV) viremia (EV). We performed a retrospective study to evaluate risk factors for PTLD in children with EV. METHODS: Among 199 pediatric kidney transplantation (KT) recipients at our center from January 2001 to October 2015, records of those with EBV viral loads of > 1,000 copies/mL and/or PTLD were reviewed. RESULTS: Diagnosis of PTLD was made in seven patients (PTLD group), and 39 patients had EV only (EV only group). The median time from KT to EV and PTLD diagnosis was 6.7 (range 0.4–47.8) months and 8.2 (range, 2.8–98.9) months, respectively. There were no significant differences between the groups in terms of sex, age at transplantation, donor type, EBV viral load, or EV-free duration after KT. Higher tacrolimus level before EV (hazard ratio, 44.5; P = 0.003) was an independent risk factor for PTLD in multivariate Cox regression analysis. Six patients with a high EBV load (median 171,639 copies/mL) were treated with preemptive rituximab (RTX) therapy, resulting in transient reduction of EBV load. None of these patients developed PTLD (median follow-up 51.5 months); however, two had neutropenia and two developed infection requiring hospital admission. CONCLUSION: In pediatric KT recipients, higher tacrolimus levels were associated with a higher incidence of PTLD. Conversely, those who received preemptive RTX for EV did not develop PTLD.
