Abdominal involvement in pediatric heart and lung transplant recipients with posttransplant lymphoproliferative disease increases the risk of mortality

Cindy C. Tai, Jennifer L. Curtis, Jacqueline R. Szmuszkovicz, Monica V. Horn, Henri Ford, Marlyn S. Woo, Kasper S. Wang

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Background: Posttransplant lymphoproliferative disease (PTLD) is a serious complication in transplant recipients. Abdominal PTLD has been reported, but the prognosis remains undefined. The purpose of this study was to identify the incidence, predisposing factors, and outcome of abdominal PTLD in pediatric cardiothoracic transplant patients. Methods: Retrospective chart review of 134 transplant patients (50 heart, 77 lung, 7 heart/lung) at our institution (1995-2005). Results: Posttransplant lymphoproliferative disease was diagnosed in 14 patients. Most were Epstein-Barr virus naive initially, but all had seroconverted when diagnosed with PTLD. Eight had abdominal involvement; 4 required surgical interventions-1 for intussusception and for bowel perforation, 2 for bowel perforation, and 1 for tumor debulking. All had lifelong follow-up, with an average follow-up of 3 years. Of 8 patients with abdominal PTLD, 4 died of complications related to PTLD, whereas 1 of 6 patients with extraabdominal PTLD died of PTLD. Conclusions: Epstein-Barr virus infection after transplantation is a major risk factor for PTLD. Pediatric patients with PTLD who present with abdominal involvement are more likely to die of PTLD than those without abdominal disease. Delay in diagnosis may contribute to the high mortality. Therefore, prompt evaluation and surveillance for possible abdominal PTLD may decrease mortality associated with this devastating problem.

Original languageEnglish (US)
Pages (from-to)2174-2177
Number of pages4
JournalJournal of Pediatric Surgery
Volume43
Issue number12
DOIs
StatePublished - Dec 1 2008
Externally publishedYes

Fingerprint

Pediatrics
Lung
Mortality
Transplant Recipients
Transplants
Epstein-Barr Virus Infections
Intussusception
Human Herpesvirus 4
Causality
Transplantation
Incidence

Keywords

  • Pediatric heart transplantation
  • Pediatric lung transplantation
  • Posttransplant lymphoproliferative disease

ASJC Scopus subject areas

  • Surgery
  • Pediatrics, Perinatology, and Child Health

Cite this

Abdominal involvement in pediatric heart and lung transplant recipients with posttransplant lymphoproliferative disease increases the risk of mortality. / Tai, Cindy C.; Curtis, Jennifer L.; Szmuszkovicz, Jacqueline R.; Horn, Monica V.; Ford, Henri; Woo, Marlyn S.; Wang, Kasper S.

In: Journal of Pediatric Surgery, Vol. 43, No. 12, 01.12.2008, p. 2174-2177.

Research output: Contribution to journalArticle

Tai, Cindy C. ; Curtis, Jennifer L. ; Szmuszkovicz, Jacqueline R. ; Horn, Monica V. ; Ford, Henri ; Woo, Marlyn S. ; Wang, Kasper S. / Abdominal involvement in pediatric heart and lung transplant recipients with posttransplant lymphoproliferative disease increases the risk of mortality. In: Journal of Pediatric Surgery. 2008 ; Vol. 43, No. 12. pp. 2174-2177.
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abstract = "Background: Posttransplant lymphoproliferative disease (PTLD) is a serious complication in transplant recipients. Abdominal PTLD has been reported, but the prognosis remains undefined. The purpose of this study was to identify the incidence, predisposing factors, and outcome of abdominal PTLD in pediatric cardiothoracic transplant patients. Methods: Retrospective chart review of 134 transplant patients (50 heart, 77 lung, 7 heart/lung) at our institution (1995-2005). Results: Posttransplant lymphoproliferative disease was diagnosed in 14 patients. Most were Epstein-Barr virus naive initially, but all had seroconverted when diagnosed with PTLD. Eight had abdominal involvement; 4 required surgical interventions-1 for intussusception and for bowel perforation, 2 for bowel perforation, and 1 for tumor debulking. All had lifelong follow-up, with an average follow-up of 3 years. Of 8 patients with abdominal PTLD, 4 died of complications related to PTLD, whereas 1 of 6 patients with extraabdominal PTLD died of PTLD. Conclusions: Epstein-Barr virus infection after transplantation is a major risk factor for PTLD. Pediatric patients with PTLD who present with abdominal involvement are more likely to die of PTLD than those without abdominal disease. Delay in diagnosis may contribute to the high mortality. Therefore, prompt evaluation and surveillance for possible abdominal PTLD may decrease mortality associated with this devastating problem.",
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