Korean J Pediatr Gastroenterol Nutr.  2003 Mar;6(1):39-46.

Posttransplant Lymphoproliferative Disorder in Pediatric Liver Transplantation: Samsung Medical Center Experience

• Choe YH
• Lee SK
• Seo JM
• Joh JW
• Kim SJ
• Lee KW
• Park JH
• Ko YH
• Kwon KY

Abstract

PURPOSE: In a retrospective study for the pediatric patients who underwent liver transplantation in the past 6 years at Samsung Medical Center, the clinical features of 5 patients with posttransplant lymphoproliferative disorder (PTLD) were analyzed.
METHODS
Between June 1996 and June 2002, 41 pediatric patients underwent liver transplantation. Seven of them died in the postoperative period. Thirty-five including one patient who died of PTLD were finally reviewed. Patients were divided into two groups: high risk group, EBV naive recipients of EBV-positive grafts; low risk group, the patients other than those in high risk group. The authors reviewed age at operation, immunosuppressive agent, postoperative duration until diagnosis, postoperative duration until EBV seroconversion, presence of treatment against rejection, and presenting symptoms of PTLD.
RESULTS
Five of 41 patients (12.2%) developed PTLD. All of them belonged to high risk group, and the incidence of PTLD in high risk group was 31.3% (5/16). The mean age at operation was 10.8 months old and the mean duration between operation and diagnosis for PTLD was 9.8 months. Primary EBV infection developed after a median of 6 months after transplantation. One patient was diagnosed as laryngeal and gastrointestinal PTLD and the other four, gastrointestinal PTLD. The following symptoms and signs were seen in the patients: anemia (100%), hypoalbuminemia (100%), fever (80%), diarrhea (80%), gastrointestinal bleeding (80%), and anorexia (60%).
CONCLUSION
PTLD is one of the major complications after pediatric liver transplantation, especially in the group of high-risk recipients. Anemia, hypoalbuminemia, fever, diarrhea and gastrointestinal bleeding were features that are characteristic of PTLD. The common features of PTLD development were: (i) EBV-positive donors placed into EBV naive recipients, (ii) primary EBV infection about 6 months after transplantation, (iii) young age, about 1 year old at operation, and (iv) the requirement for intensive posttransplant immunosuppression.

Keyword

Posttransplant lymphoproliferative disorder; Pediatric liver transplantation; Epstein-Barr virus infection; Immunosuppression; Hypoalbuminemia; Anemia; Gastrointestinal bleeding

MeSH Terms

Anemia
Anorexia
Diagnosis
Diarrhea
Epstein-Barr Virus Infections
Fever
Hemorrhage
Herpesvirus 4, Human
Humans
Hypoalbuminemia
Immunosuppression
Incidence
Liver Transplantation*
Liver*
Lymphoproliferative Disorders*
Postoperative Period
Retrospective Studies
Tissue Donors
Transplants