The changing face of post-transplant lymphoproliferative disease in the era of molecular EBV monitoring

Abstract

Pediatric PTLD is often associated with primary EBV infection and immunosuppression. The aim was to retrospectively review the spectrum of histologically documented PTLD for two time intervals differentiated by changes in use of molecular EBV monitoring. Eleven of 146 patients (7.5%) in 2001-2005 (Era A) and 10 of 92 (10.9%) in 1993-1997 (Era B) were diagnosed with PTLD. The median age at liver transplantation (0.8 and 0.9 yr, respectively) and the median duration between liver transplant and diagnosis of PTLD (0.6 and 0.7 yr, respectively) were similar in both eras. However, patients in Era A presented with significantly less advanced histological disease compared to patients in Era B (p=0.03). Specifically, nine patients (82%) in Era A had Pl hyperplasia/polymorphic PTLD, whereas in Era B, six had advanced histological disease (five monomorphic and one unclassified). Three transplant recipients in Era B died secondary to PTLD, whereas there were no PTLD-related deaths in Era A (p=0.03). Heightened awareness of risk for PTLD, alterations in baseline immunosuppression regimens, implementation of molecular EBV monitoring, pre-emptive reduction in immunosuppression and improved therapeutic options may have all contributed to a milder PTLD phenotype and improved clinical outcomes.

Hepatic involvement by lymphoproliferative disorders post liver transplantation: PTLD.Int. Survey

“…A total of 21 international published studies [13,[20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39] were found that met our criteria. Table 1 summarizes data of the enrolled studies.…”

Posttransplant lymphoproliferative disease following liver transplantation

“…In the latter period, patients had less advanced histological disease at presentation and no deaths, compared to advanced disease and 3 deaths in the earlier era. The difference was ascribed to implementation of molecular EBV monitoring and preemptive reduction in immunosuppression [7]. …”

“…In liver transplant recipients, PTLD is reported in up to 2.8% of adults and up to 15% of children [3]. Mortality has been reported as high as 50%, although current management strategies appear to result in improved outcomes [4–7]. Here we will review the pathophysiology, risk factors, clinical presentation, and management of PTLD after liver transplantation.…”

Prevention and Treatment for Epstein–Barr Virus Infection and Related Cancers

“…Preemptive IS alleviation (tacrolimus tapering, corticoids arrest) induced lowering of viral load in all and led to rejection in 1/11 patient. Another retrospective comparison of children after liver transplantation with or without EBV load monitoring (2001-2005 and 1993-1997), with preemptive IS tapering in case of high viral load, showed no difference in PTLD incidence (7.5 and 10.9 %, respectively) (Kerkar et al 2010). PTLD occurring in the 2001-2005 era were, however, less advanced (polymorphic versus monomorphic, p = 0.03), with no mortality as compared to 3/10 deaths before.…”