Posttransplant lymphoproliferative disease following liver transplantation

Kamdar, Kala Y.; Rooney, Cliona M.; Heslop, Helen E.

doi:10.1097/mot.0b013e3283465715

Cited by 89 publications

(59 citation statements)

References 63 publications

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“…Most of PTLD are of B cell in origin and EBV is present in majority. 81,82 EBV negative PTLD is associated with later onset, monomorphic histology and aggressive clinical behavior similar to lymphomas in immuno competent patients. 83 Risk factors for PTLD include Epstein-Barr virus seronegativity at transplant, younger age, intensity of immunosuppression and the first year posttransplant.…”

Section: Development Of De Novo Malignancies and Posttransplant Lymphmentioning

confidence: 99%

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Current Status of Immunosuppression in Liver Transplantation

Choudhary

Saigal

Shukla

et al. 2013

Journal of Clinical and Experimental Hepatology

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With advancements in immunosuppressive strategies and availability of better immunosuppressive agents, survival rate following liver transplantation has improved significantly in the recent times. Besides improvements in surgical techniques, the most important factor that has contributed to this better outcome is the progress made in the field of immunosuppression. Over the last several years, the trend has changed to tailored immunosuppression with the aim of achieving optimal graft function while avoiding its undesirable side effects. Induction agents are no longer used routinely and the aim is to provide minimal immunosuppression in the maintenance phase. The present review discusses the various types of immunosuppressive agents, their mechanism of action, clinical utility, advantages and disadvantages, and their side effects in short and long-term. It also discusses about tailoring immunosuppression in presence of various situations such as renal dysfunction, metabolic syndrome, hepatitis C recurrence, cytomegalovirus infections and so on. The issue of chronic kidney disease and the available renal sparing immunosuppressive strategies has been particularly stressed upon. Finally, it discusses about the practical aspects of various immunosuppression regimens including drug monitoring. ( J CLIN EXP HEPATOL 2013;3:150-158)

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Section: Development Of De Novo Malignancies and Posttransplant Lymphmentioning

confidence: 99%

“…In patients diagnosed with PTLD, management options include reduction of immunosuppression, rituximab, combination chemotherapy, and adoptive immunotherapy. 81,82 Steroid Free Immunosuppression…”

Section: Development Of De Novo Malignancies and Posttransplant Lymphmentioning

confidence: 99%

Current Status of Immunosuppression in Liver Transplantation

Choudhary

Saigal

Shukla

et al. 2013

Journal of Clinical and Experimental Hepatology

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“…EBV-associated PTLD is an uncommon but serious complication of LT with an incidence in adults of less than 3%. 116,117 Risk factors for development include a primary EBV infection, CMV donor-recipient mismatch; presence of CMV disease, and augmentation immunosuppression. 118 The association of PTLD with EBV infection is variable in adult LT recipients; later onset PTLD is less likely to be EBV-associated.…”

Section: Epstein-barr Virusmentioning

confidence: 99%

Infections After Orthotopic Liver Transplantation

Pedersen

Seetharam

2014

Journal of Clinical and Experimental Hepatology

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Opportunistic infections are a leading cause of morbidity and mortality after orthotopic liver transplantation. Systemic immunosuppression renders the liver recipient susceptible to de novo infection with bacteria, viruses and fungi post-transplantation as well to reactivation of pre-existing, latent disease. Pathogens are also transmissible via the donor organ. The time from transplantation and degree of immunosuppression may guide the differential diagnosis of potential infectious agents. However, typical systemic signs and symptoms of infection are often absent or blunted after transplant and a high index of suspicion is needed. Invasive procedures are often required to procure tissue for culture and guide antimicrobial therapy. Antimicrobial prophylaxis reduces the incidence of opportunistic infections and is routinely employed in the care of patients after liver transplant. In this review, we survey common bacterial, fungal, and viral infections after orthotopic liver transplantation and highlight recent developments in their diagnosis and management. ( J CLIN EXP HEPATOL 2014;4:347-360) I nfection after orthotopic liver transplantation (OLT) is a major cause of morbidity and mortality. Infection is estimated to occur in upto 80% of organ recipients. Bacterial infections are most frequent (70%), followed by viral (20%) and fungal infections (8%). 1,2,3 In addition to direct effects of infection and end-organ inflammation, pathogens may have a number of indirect effects that result in allograft injury, rejection and opportunistic superinfection.The risk of infection in liver transplant recipients is determined by the intensity of exposure to infectious agents and the overall level of immunosuppression. 4 In addition, conditions attendant to end-stage liver disease in the immediate perioperative period may render a recipient vulnerable to infection and include: neutropenia, deficits in mucocutaneous barrier integrity, presence of necrotic tissue, ischemia, diabetes mellitus, immunomodulating viruses, uremia, and protein-calorie malnutrition. 5 Infectious exposures come from many sources post liver transplant including: de novo (acquired acute) in the recipient, reactivation in the recipient, the donor organ, and nosocomial and time from transplant may provide clues to etiology (Figure 1). The overall level of immunosuppression is dependent upon the dose, duration, and choice of immunosuppression as well as underlying immune deficiencies. 6 Inflammatory responses to invading pathogens are often blunted by immunosuppressive therapy, and as a result, the classic signs or symptoms of infection may be absent. A high index of suspicion is need in the liver recipient, and a low threshold to perform invasive diagnostic procedures is often required. It is critical to identify clinical factors that predispose recipients to infection and much interest centers on identifying risk factors for infection after liver transplant. GENETIC POLYMORPHISMS IN THE INNATE IMMUNE SYSTEMIn addition to clinical factors that promote ...

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“…Management options include reduction of immunosuppression, rituximab, combination chemotherapy, and adoptive immunotherapy through the aid of the oncology team. 59 Liver transplant recipients are at increased risk for other cancers as well, with an estimated 10-year probability of developing a gastrointestinal, lung, female genitourinary, or oropharyngeal/laryngeal cancer at 3.6%, 2.0%, 1.8%, and 1.1%, respectively. 52 This increased risk is seen largely in the transplant population with previous or current alcohol-related disease or PSC.…”

Section: Malignancymentioning

confidence: 99%

Long-term Medical Management of the Liver Transplant Recipient: What the Primary Care Physician Needs to Know

Singh

Watt

2012

Mayo Clinic Proceedings

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Recognition, management, and prevention of medical complications and comorbidities after liver transplant is the key to improved long-term outcomes. Beyond allograft-related complications, metabolic syndrome, cardiovascular disease, renal dysfunction, and malignancies are leading causes of morbidity and mortality in this patient population. Primary care physicians have an important role in improving outcomes of liver transplant recipients and are increasingly relied on for managing these complex patients. This review serves to assist the primary care physician in the long-term management issues of liver transplant recipients.

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Posttransplant lymphoproliferative disease following liver transplantation

Cited by 89 publications

References 63 publications

Current Status of Immunosuppression in Liver Transplantation

Current Status of Immunosuppression in Liver Transplantation

Infections After Orthotopic Liver Transplantation

Long-term Medical Management of the Liver Transplant Recipient: What the Primary Care Physician Needs to Know

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