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Risk factors and clinical outcomes of pediatric liver transplant recipients with post‐transplant lymphoproliferative disease in a multi‐ethnic Asian cohort
Author(s) -
Huang James Guoxian,
Tan Mervin Ye Qing,
Quak SengHock,
Aw Marion Margaret
Publication year - 2018
Publication title -
transplant infectious disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.69
H-Index - 67
eISSN - 1399-3062
pISSN - 1398-2273
DOI - 10.1111/tid.12798
Subject(s) - medicine , odds ratio , confidence interval , univariate analysis , liver transplantation , multivariate analysis , retrospective cohort study , transplantation , gastroenterology , immunology
Abstract Background We aimed to evaluate clinical characteristics, risk factors, and disease outcomes for liver transplant recipients ( LTR ) with post‐transplant lymphoproliferative disease ( PTLD ) at our center. Methods Retrospective review of data of all pediatric LTR (1991‐2015) was conducted. Results The overall incidence of PTLD was 16.4% (18/110), the majority (13/18) were early lesions, while 3/18 were polymorphic/monomorphic PTLD . The risk factors significant on univariate analysis were as follows: mean age (years) at transplant (1.66 vs 4.76, P = .006); age <2 years at transplant (odds ratio [ OR ] 3.53 [95% confidence interval [ CI ]: 1.16‐10.73], P = .026); cytomegalovirus ( CMV ) primary infection ( OR 11.39 [95% CI : 3.44‐37.7], P < .001); recipient CMV seronegativity ( OR 7.50 [95% CI : 2.02‐27.78], P = .003); presence of CMV end‐organ disease ( OR 4.00 [95% CI : 1.22‐13.16], P = .022); Chinese ethnicity; and higher mean duration of intravenous ganciclovir prophylaxis. In multivariate analysis, CMV primary infection ( OR 5.22 [95% CI : 1.25‐21.87], P = .024), CMV seronegativity ( OR 5.91 [95% CI : 1.13‐30.90, P = .035]), and having acute cellular rejections ( ACR ) prior to PTLD ( OR 5.53 [95% CI : 1.43‐21.48, P = .013]) were significant risk factors for PTLD , with the latter two factors having a synergistic effect in increasing PTLD risk in a stratified analysis. The final multivariate model in predicting the risk of PTLD , utilizing CMV primary infection, recipient CMV seronegativity, and ACR before PTLD as predictive variables, was statistically significant (likelihood ratio chi square statistic = 25.18, P < .0001 with df = 3). Conclusions We report a unique clinicopathologic and risk factor profile in our cohort—early lesion PTLD accounts for the majority and the incidence of monomorphic PTLD remains low. In addition, we show a synergism between CMV naivety and ACR on PTLD risk, a higher prevalence of gastrointestinal manifestations, and a lack of significant association with Epstein‐Barr virus seronegativity.