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Graft rejection in pediatric liver transplant patients with Epstein‐Barr viremia and post‐transplant lymphoproliferative disease
Author(s) -
Weiner Chana,
Weintraub Lauren,
Wistinghausen Birte,
Tomaino Juli,
Ar Ronen,
Kerkar Nanda,
Miloh Tamir
Publication year - 2012
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.1399-3046.2012.01713.x
Subject(s) - medicine , lymphoproliferative disorders , gastroenterology , viremia , risk factor , transplantation , methylprednisolone , lymphoproliferative disease , immunosuppression , lymphoma , immunology , human immunodeficiency virus (hiv)
Weiner C, Weintraub L, Wistinghausen B, Tomaino J, Arnon R, Kerkar N, Miloh T. Graft rejection in pediatric liver transplant patients with Epstein‐Barr viremia and post‐transplant lymphoproliferative disease. Abstract: Treatment of primary EV and PTLD in pediatric LT recipients (pLT) involves IS reduction/cessation. Retrospective review of pLT at our institution from 2001–2009 was conducted to characterize risk factors for GR after EV/ PTLD. Of 184 pLT, EV occurred in 61 (33%) at mean 16.5 m (0–82) and PTLD in 18 (9.8%) at mean 17.7 m (3–78) post‐LT. Median age at pLT was 11 m (1–245 m) and follow‐up six yr. For EV, 86% underwent IS reduction and 51% received antivirals. GR occurred in 12 (27.9%) with EV and 15 (83.3%) after PTLD diagnosis (relative risk of GR for PTLD 2.98). GR treated with methylprednisolone bolus in half and/or oral IS in half. Following GR therapy, four had PTLD relapses, no graft loss and one EV patient required re‐transplantation. GR history before EV was a risk factor for GR after EV (p = 0.024). GR at any point after pLT was a risk factor for PTLD (p = 0.001). Children with EV and GR prior to EV should be monitored closely for GR after IS reduction and GR is a significant risk factor for PTLD. Most children with PTLD eventually developed GR.