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Risk factors for post‐transplant lymphoproliferative disorder in pediatric patients: A case‐control study
Author(s) -
Allen Upton D.,
Farkas Gabrielle,
Hébert Diane,
Weitzman Sheila,
Stephens Derek,
Petric Martin,
Tellier Raymond,
Ngan Bo,
Fecteau Annie,
West Lori,
Wasfy Samia
Publication year - 2005
Publication title -
pediatric transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.457
H-Index - 69
eISSN - 1399-3046
pISSN - 1397-3142
DOI - 10.1111/j.1399-3046.2005.00318.x
Subject(s) - medicine , post transplant lymphoproliferative disorder , lymphoproliferative disorders , viral load , transplantation , gastroenterology , epstein–barr virus , case control study , biopsy , immunology , pediatrics , virus , lymphoma
Post‐transplant Lymphoproliferative Disorder (PTLD) because of the Epstein–Barr Virus (EBV) is a major concern after pediatric transplantation. The group at greatest risk is EBV‐seronegative recipients who receive EBV‐seropositive organs. Additional risk factors remain to be determined, including those among EBV‐seropositive recipients. In this case‐control study, PTLD cases were biopsy‐proven over a period of 4 yr (1997–2000, inclusive). Each case was matched with 2 controls, based on the type of organ transplanted and the period of transplantation (±1 yr). Variables compared between cases and controls included those relating to the clinical and virologic profiles and immunosuppressive therapy. Twenty‐two cases of PTLD were diagnosed during the study period. PTLD cases occurred at a median of 22.8 months post‐transplantation (range 1–131). The median age of cases was 26.2 months (range 6.1–194) compared with 47.4 months (range 0.8–202.2) for controls (p = 0.93). Cases had a higher mean baseline EBV load compared with controls (3.1 log 10 (s.d. ± 1.0) vs. 1.6 log 10 /10 6 PBMCs (s.d. ± 1.4), with every 1 log increase in viral load resulting in a three times increase in the likelihood of PTLD (p < 0.007). Close to one in four cases of PTLD were EBV‐seropositive pretransplantation. These seropositive recipients tended to be older patients with a trend to a worse outcome compared with their seronegative counterparts. The occurrence of PTLD was not associated with the use of any specific immunosuppressants. A significant proportion of PTLD cases occurred among EBV‐seropositive transplant recipients, with a tendency towards an unfavorable outcome. Besides EBV‐seronegative recipients who receive seropositive organs, some EBV‐seropositive pediatric patients are at risk of PTLD. Additional studies are warranted to further define the factors associated with PTLD in EBV‐seropositive transplant recipients.