Posttransplant Lymphoproliferative Disorders in Cardiac Transplant Patients

Fatio, Renata; Sütsch, Gabor; Mayer, Kurt; Follath, F; Corti, Rodolfo; Gallino, Augusto; Kiowski, Wolfgang

doi:10.1016/s0041-1345(98)00175-4

Cited by 9 publications

(12 citation statements)

References 19 publications

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“…PTLD is a potentially fatal condition manifested by an abnormal expansion of lymphocytic cells [4][5][6][7][8][9][10] . It may have a variable distribution, affecting several organs and tissues.…”

Section: Discussionmentioning

confidence: 99%

“…Among the PTLD cases, those with B cell phenotype are known to be more prevalent, whereas those with T cell phenotype are less frequent, more aggressive, and are associated with late complications in the transplanted organs 6 .…”

Section: Discussionmentioning

confidence: 99%

“…Studies have shown that the optimal immunosuppressive therapy would be one using the minimum dose able to suppress rejection, since an the excessive treatment would allow the development of PTLD 3,4,6,10 . Reduction of immunosuppression, however, may lead to a regression of PTLD, because it enables the reactivation of T lymphocytes against EBV expression 9 .…”

Section: Discussionmentioning

confidence: 99%

“…Successful treatment of PTLD with acyclovir and granciclovir have been demonstrated, both by increasing survival rates of patients and by preventing acute rejections 4,6 . However, some authors have shown that the administration of these antiviral drugs is inefficient because they only suppress EBV replication in its linear form, but not in its latent form 8 .…”

Section: Discussionmentioning

confidence: 99%

“…Immunosuppressive therapy that transplanted patients have to undergo in order to prevent organ rejection exposes them to a high risk of developing neoplasms, mainly posttransplantation lymphoproliferative disorders (PTLD) [2][3][4][5][6][7] . The exact incidence of PTLD is unknown, ranging from 2% to 20%; however it is known to be higher among children 5,8 .…”

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confidence: 99%

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Desordem linfoproliferativa pós-transplante em paciente pediátrico

Pêgo-Fernandes¹,

Azeka²,

Odoni³

et al. 2006

Arq. Bras. Cardiol.

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Immunosuppressive therapy for transplanted patients exposes them to a high risk of developing posttransplantation lymphoproliferative disorders (PTLD). We report the case of a child undergoing heart transplantation at seven months of age who developed PTLD at nine years of age, diagnosed by resection of a pulmonary nodule. In the past few years, because of the improved preservation of donated organs and of the larger experience with immunosuppressive therapy, a significant increase in the survival of children after heart transplantation has been observed. Thus, transplantation has become a broadly accepted therapeutic option for children and adolescents with congenital heart defects or cardiomyopathies in advanced stages 1-3 .Immunosuppressive therapy that transplanted patients have to undergo in order to prevent organ rejection exposes them to a high risk of developing neoplasms, mainly posttransplantation lymphoproliferative disorders (PTLD) 2-7 . The exact incidence of PTLD is unknown, ranging from 2% to 20%; however it is known to be higher among children 5,8 .A higher frequency of PTLD is observed among children because the great majority of them had not been exposed to the Epstein-Barr virus (EBV) prior to heart transplantation. Therefore, post-transplantation seroconversion is a significant risk factor for the development of PTLD 5,9,10 . Of the pediatric patients who seroconvert after heart transplantation, approximately 63% develop PTLD 9 .The EBV is believed to play a key role in the pathogenesis of PTLD 4 . This virus is able to enter B cells and induce their proliferation, which is normally controlled by many immune mechanisms such as proliferation and activation of cytotoxic T lymphocytes. Anti-rejection immunosuppressive drugs inhibit the response of these cytotoxic T lymphocytes, which results in the proliferation of B cells induced by EBV 7 .Treatment modalities for PTLD are varied and include reduction of the immunosuppressive therapy, control of EBV replication, conventional antineoplastic therapy (radiotherapy, chemotherapy, and surgery) and immunotherapy 8 . However, mortality rates are quite significant, varying according to prognostic factors and the treatment chosen 8,10 .The purpose of this publication is to report the case of a child undergoing heart transplantation at seven months of age who developed PTLD eight years and nine months later, diagnosed by resection of a pulmonary nodule. Case ReportMale, nine years old, male, who underwent heart transplantation at seven months of age because of dilated cardiomyopathy.In 2000, he had a respiratory disorder characterized by persistent cough with yellowish sputum, and was diagnosed with bronchopneumonia. He was initially treated with amoxicillin for fourteen days, and cefepime for thirteen days. In 2001, a control chest computed tomography (CT) revealed perihilar lymph nodes and solid masses within the lungs with a progressive evolution, suggestive of an infectious and secondarily tumoral disorder, and the patient was hospitalized for invest...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Desordem linfoproliferativa pós-transplante em paciente pediátrico

Pêgo-Fernandes¹,

Azeka²,

Odoni³

et al. 2006

Arq. Bras. Cardiol.

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Tumorerkrankungen nach Herztransplantation

Hoffmeier¹,

Wagner²,

Nashan

et al. 2002

Z Kardiol

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Up to 30% of patients with an organ transplantation develop precancerous lesions and malignant tumors, especially of the skin. All 241 patients who underwent heart transplantation from 1990 to 2000 were evaluated with regard to the development of neoplasias. Those alive in September 1999 were referred for a standardized dermatological exam (n=156) which detected malignancy in 28 patients being transplanted for 4.98 years on average. The skin was the organ most frequently involved (64%, n=18). 18% (n=5) of tumors were found in the urinary and genital tract, 7% (n=2) each in the respiratory and gastrointestinal tract, and 4% (n=1 ) in the breasts. The average age of patients who developed tumors was significantly higher as compared to the overall mean age (59.5+/-5 vs 49.8+/-14.7 years, p=0.00027). There was no correlation between development of malignancy and HLA matching, immunosuppressive drugs used, dosage and serum levels of immunosuppressive medication, and episodes of transplant rejection. Our study shows that the risk to develop tumors is at least doubled after heart transplantation. Due to the high incidence of skin tumors, transplant patients should undergo dermatological examinations on a regular basis.

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Long-Term Challenges of Immunosuppression in Pediatric Patients

Kelly

2005

Transplantation Proceedings

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Posttransplant Lymphoproliferative Disorders in Cardiac Transplant Patients

Cited by 9 publications

References 19 publications

Desordem linfoproliferativa pós-transplante em paciente pediátrico

Desordem linfoproliferativa pós-transplante em paciente pediátrico

Tumorerkrankungen nach Herztransplantation

Long-Term Challenges of Immunosuppression in Pediatric Patients

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