Graft rejection in pediatric liver transplant patients with Epstein-Barr viremia and post-transplant lymphoproliferative disease

Chana Weiner, Lauren Weintraub, Birte Wistinghausen, Juli Tomaino, Ronen Arnon, Nanda Kerkar, Tamir Miloh

Research output: Contribution to journalArticlepeer-review

7 Scopus citations

Abstract

Treatment of primary EV and PTLD in pediatric LT recipients (pLT) involves IS reduction/cessation. Retrospective review of pLT at our institution from 2001-2009 was conducted to characterize risk factors for GR after EV/ PTLD. Of 184 pLT, EV occurred in 61 (33%) at mean 16.5 m (0-82) and PTLD in 18 (9.8%) at mean 17.7 m (3-78) post-LT. Median age at pLT was 11 m (1-245 m) and follow-up six yr. For EV, 86% underwent IS reduction and 51% received antivirals. GR occurred in 12 (27.9%) with EV and 15 (83.3%) after PTLD diagnosis (relative risk of GR for PTLD 2.98). GR treated with methylprednisolone bolus in half and/or oral IS in half. Following GR therapy, four had PTLD relapses, no graft loss and one EV patient required re-transplantation. GR history before EV was a risk factor for GR after EV (p = 0.024). GR at any point after pLT was a risk factor for PTLD (p = 0.001). Children with EV and GR prior to EV should be monitored closely for GR after IS reduction and GR is a significant risk factor for PTLD. Most children with PTLD eventually developed GR.

Original languageEnglish (US)
Pages (from-to)458-464
Number of pages7
JournalPediatric Transplantation
Volume16
Issue number5
DOIs
StatePublished - Aug 2012
Externally publishedYes

Keywords

  • epstein barr virus
  • pediatric liver transplantation
  • PTLD
  • rejection

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Transplantation

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