Risk factors for post‐transplant lymphoproliferative disorder in pediatric patients: A case‐control study

Pediatric Transplantation - Tập 9 Số 4 - Trang 450-455 - 2005
Upton Allen1, Gabrielle Farkas2, Diane Hebért3, Sheila Weitzman4, Derek Stephens5, Martin Petric6, Raymond Tellier6, Bo Ngan6, Annie Fecteau7, Lori J. West8, Samia Wasfy1
1Division of Infectious Diseases, The Department of Pediatrics, Hospital for Sick Children, University of Toronto, Ontario
2The University of Western Ontario, Ontario
3Division of Nephrology, The Department of Pediatrics, Hospital for Sick Children
4Division of Haematology/Oncology, The Department of Pediatrics, Hospital for Sick Children
5The Research Institute, Hospital for Sick Children
6The Department of Pediatric Laboratory Medicine, Hospital for Sick Children
7The Department of General Surgery, Hospital for Sick Children
8Division of Cardiology, The Department of Pediatrics, Hospital for Sick Children, University of Toronto, Ontario, Canada

Tóm tắt

Abstract:  Post‐transplant Lymphoproliferative Disorder (PTLD) because of the Epstein–Barr Virus (EBV) is a major concern after pediatric transplantation. The group at greatest risk is EBV‐seronegative recipients who receive EBV‐seropositive organs. Additional risk factors remain to be determined, including those among EBV‐seropositive recipients. In this case‐control study, PTLD cases were biopsy‐proven over a period of 4 yr (1997–2000, inclusive). Each case was matched with 2 controls, based on the type of organ transplanted and the period of transplantation (±1 yr). Variables compared between cases and controls included those relating to the clinical and virologic profiles and immunosuppressive therapy. Twenty‐two cases of PTLD were diagnosed during the study period. PTLD cases occurred at a median of 22.8 months post‐transplantation (range 1–131). The median age of cases was 26.2 months (range 6.1–194) compared with 47.4 months (range 0.8–202.2) for controls (p = 0.93). Cases had a higher mean baseline EBV load compared with controls (3.1 log10 (s.d. ± 1.0) vs. 1.6 log10/106 PBMCs (s.d. ± 1.4), with every 1 log increase in viral load resulting in a three times increase in the likelihood of PTLD (p < 0.007). Close to one in four cases of PTLD were EBV‐seropositive pretransplantation. These seropositive recipients tended to be older patients with a trend to a worse outcome compared with their seronegative counterparts. The occurrence of PTLD was not associated with the use of any specific immunosuppressants. A significant proportion of PTLD cases occurred among EBV‐seropositive transplant recipients, with a tendency towards an unfavorable outcome. Besides EBV‐seronegative recipients who receive seropositive organs, some EBV‐seropositive pediatric patients are at risk of PTLD. Additional studies are warranted to further define the factors associated with PTLD in EBV‐seropositive transplant recipients.

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Tài liệu tham khảo

10.1056/NEJM198204153061506

10.1002/ijc.2910030619

10.1016/S0140-6736(84)90994-2

Shapiro RS, 1988, Epstein–Barr virus‐associated B cell lymphoproliferative disorders following bone marrow transplantation, Blood, 71, 1234, 10.1182/blood.V71.5.1234.1234

Nalesnik MA, 1988, The pathology of post‐transplant lymphoproliferative disorders occurring in the setting of cyclosporine A‐prednisone immunosuppression, Am J Pathol, 133, 173

10.1056/NEJM198910193211604

10.1097/00000658-198309000-00012

10.1093/infdis/152.5.876

10.1093/clinids/20.5.1346

10.1097/00007890-198804000-00011

10.1097/00007890-199502270-00015

10.1097/00007890-199608150-00012

10.1034/j.1399-3046.1999.00066.x

Harris NL, 1997, Posttransplant lymphoproliferative disorders: summary of Society for Hematopathology Workshop, Semin Diagn Pathol, 14, 8

10.1086/321806

Centers for Disease Control and Prevention, 2001, Epi Info, Version 6.04d

Savoie A, 1994, Direct correlation between the load of Epstein–Barr virus‐infected lymphocytes in the peripheral blood of pediatric transplant patients and risk of lymphoproliferative disease, Blood, 83, 2715, 10.1182/blood.V83.9.2715.2715

10.1182/blood.V84.3.972.972

10.1097/00007890-199509270-00005

10.1046/j.1600-6135.2003.00274.x

10.1034/j.1600-6143.2002.21019.x

Henle G, 1969, Antibodies to EB virus in Burkitt's lymphoma and control groups, J Natl Cancer Inst, 43, 1147

10.1093/infdis/121.3.303

10.1097/00007890-199205000-00033

10.1093/ajcp/99.3.265

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Pediatric Transplantation

Tập 9 Số 4

450-455

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