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- Title
Epstein–Barr virus‐associated post‐transplant lymphoproliferative disorders in pediatric transplantation: A prospective multicenter study in the United States.
- Authors
Tajima, Tetsuya; Martinez, Olivia M.; Bernstein, Daniel; Boyd, Scott D.; Gratzinger, Dita; Lum, Grant; Sasaki, Kazunari; Tan, Brent; Twist, Clare J.; Weinberg, Kenneth; Armstrong, Brian; Desai, Dev M.; Mazariegos, George V.; Chin, Clifford; Fishbein, Thomas M.; Tekin, Akin; Venick, Robert S.; Krams, Sheri M.; Esquivel, Carlos O.
- Abstract
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.
- Subjects
UNITED States; LYMPHOPROLIFERATIVE disorders; TRANSPLANTATION of organs, tissues, etc.; EPSTEIN-Barr virus; LONGITUDINAL method; VIRAL load; MUSCLE tumors
- Publication
Pediatric Transplantation, 2024, Vol 28, Issue 4, p1
- ISSN
1397-3142
- Publication type
Article
- DOI
10.1111/petr.14763