Epstein-Barr virus-associated post-transplant lymphoproliferative disorders in pediatric transplantation: A prospective multicenter study in the United States.

Autor: Tajima T; Division of Abdominal Transplantation, Department of Surgery, Stanford University School of Medicine, Stanford, California, USA., Martinez OM; Division of Abdominal Transplantation, Department of Surgery, Stanford University School of Medicine, Stanford, California, USA., Bernstein D; Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA., Boyd SD; Department of Pathology, Stanford University School of Medicine, Stanford, California, USA., Gratzinger D; Department of Pathology, Stanford University School of Medicine, Stanford, California, USA., Lum G; Division of Abdominal Transplantation, Department of Surgery, Stanford University School of Medicine, Stanford, California, USA., Sasaki K; Division of Abdominal Transplantation, Department of Surgery, Stanford University School of Medicine, Stanford, California, USA., Tan B; Department of Pathology, Stanford University School of Medicine, Stanford, California, USA., Twist CJ; Department of Pediatric Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA., Weinberg K; Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA., Armstrong B; Rho Federal Systems Division, Rho, Durham, North Carolina, USA., Desai DM; Division of Surgical Transplantation, University of Texas (UT) Southwestern Medical Center, Dallas, Texas, USA., Mazariegos GV; Department of Pediatrics, University of Pittsburgh Medical Center (UPMC) Children's Hospital, Pittsburgh, Pennsylvania, USA., Chin C; Department of Pediatrics and Cincinnati Children's Hospital, University of Cincinnati, Cincinnati, Ohio, USA., Fishbein TM; Department of Surgery and Pediatrics, MedStar Georgetown University Hospital, Washington, DC, USA., Tekin A; Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA., Venick RS; Department of Pediatric Gastroenterology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA., Krams SM; Division of Abdominal Transplantation, Department of Surgery, Stanford University School of Medicine, Stanford, California, USA., Esquivel CO; Division of Abdominal Transplantation, Department of Surgery, Stanford University School of Medicine, Stanford, California, USA.
Jazyk: angličtina
Zdroj: Pediatric transplantation [Pediatr Transplant] 2024 Jun; Vol. 28 (4), pp. e14763.
DOI: 10.1111/petr.14763
Abstrakt: Background: Epstein-Barr virus (EBV)-associated post-transplant lymphoproliferative disorders (PTLD) is the most common malignancy in children after transplant; however, difficulties for early detection may worsen the prognosis.
Methods: The prospective, multicenter, study enrolled 944 children (≤21 years of age). Of these, 872 received liver, heart, kidney, intestinal, or multivisceral transplants in seven US centers between 2014 and 2019 (NCT02182986). In total, 34 pediatric EBV+ PTLD (3.9%) were identified by biopsy. Variables included sex, age, race, ethnicity, transplanted organ, EBV viral load, pre-transplant EBV serology, immunosuppression, response to chemotherapy and rituximab, and histopathological diagnosis.
Results: The uni-/multivariable competing risk analyses revealed the combination of EBV-seropositive donor and EBV-naïve recipient (D+R-) was a significant risk factor for PTLD development (sub-hazard ratio: 2.79 [1.34-5.78], p = .006) and EBV DNAemia (2.65 [1.72-4.09], p < .001). Patients with D+R- were significantly more associated with monomorphic/polymorphic PTLD than those with the other combinations (p = .02). Patients with monomorphic/polymorphic PTLD (n = 21) had significantly more EBV DNAemia than non-PTLD patients (p < .001) and an earlier clinical presentation of PTLD than patients with hyperplasias (p < .001), within 6-month post-transplant. Among non-liver transplant recipients, monomorphic/polymorphic PTLD were significantly more frequent than hyperplasias in patients ≥5 years of age at transplant (p = .01).
Conclusions: D+R- is a risk factor for PTLD and EBV DNAemia and associated with the incidence of monomorphic/polymorphic PTLD. Intensive follow-up of EBV viral load within 6-month post-transplant, especially for patients with D+R- and/or non-liver transplant recipients ≥5 years of age at transplant, may help detect monomorphic/polymorphic PTLD early in pediatric transplant.
(© 2024 The Authors. Pediatric Transplantation published by Wiley Periodicals LLC.)
Databáze: MEDLINE
Externí odkaz: