Post-Transplant Lymphoproliferative Disorder (PTLD) Associated EBV
Viremia After Liver Transplantation in Children: Experience from Single
Center
Abstract
Objective: The most prevalent malignancy that complicates both
adult and pediatric solid organ transplantation is post-transplant
lymphoproliferative disorder (PTLD). This study aimed to analyze the
clinical and pathological characteristics, treatments, and outcomes of
EBV viremia and PTLD in pediatric liver transplant recipients.
Method: A retrospective chart review was performed on 112
patients less than 18 years of age who underwent isolated orthotopic
liver transplantation (OLT) between 2010 and 2022 at Ege University
Children’s Hospital. Data gathered for 1-year post-OLT included age at
OLT, EBV, immunoglobulin (Ig)M/IgG status of the donor and recipient,
indication for OLT, induction regimen, all immunosuppression levels,
date and result of EBV polymerase chain reaction (PCR) testing,
rejection episodes documented by liver biopsy, and the development of
PTLD. Result: Forty-nine patients (43.75%) developed EBV
viremia (median interval from surgery: two months, min-max 2-36), of
which 43 (87.8%) grafts came from living donors, and 6 (12.2%) came
from deceased donors. Nine (18.4%) patients died during follow-up, and
eight (16.3%) developed PTLD. Five patients developed EBV-related
disease; one child developed hemophagocytic lymphohistiocytosis; one
developed aplastic anemia; and one child developed B cell lymphoma. When
PTLD patients and without-PTLD patients were compared, pediatric
intensive care unit hospitalization, abnormal bone marrow biopsy
findings, lymphadenopathy, age at diagnosis of EBV viremia, EBV viral
load, tacrolimus (FK 506) pre-infection, and 1-month levels were higher
in patients with PTLD (p<0.05). In logistic regression
analysis, we showed that the age at diagnosis of EBV viremia was
significantly higher in children with PTLD (p=0.045; OR, 1.389; 95% CI,
1.007-1.914). Discussion PTLD is a rare but severe complication
associated with EBV after OLT. This study demonstrated that PTLD is
associated with older age, higher tacrolimus blood levels before EBV
viremia, at one month of EBV viremia, and higher peak EBV viral load.