2017 - CIRTA


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5- Outcomes after Intestinal Transplantation

16.5 - Post transplant lymphoproliferative disorders and intestinal transplant in children - single center experience

Presenter: Yung Ching, Ming, Taoyuan City , Taiwan
Authors: Yung Ching Ming

Post transplant lymphoproliferative disorders and intestinal transplant in children - single center experience

Yung Ching Ming1,2.

1Transplant Surgery, Children's Hospital of UPMC, Pittsburgh, PA, United States; 2Pediatric Surgery, Linkou CGMH, Taoyuan, Taiwan

Introduction: Post transplant lymphoproliferative disorders (PTLDs) are important and potentially lethal complication post intestinal transplant. We present herein our experience of pediatric intestinal transplantation with PTLDs to evaluate their relationship and to identify possible risk factors.

Methods: From July 1990 to June 2016, the medical record of patients who underwent small bowel transplant in our institute were evaluated retrospectively. The types of graft included isolated small bowel (ISB), liver and small bowel (LSB) and multivisceral or modified multivisceral (MV or MMV). We divided the patients into several different groups to explore the risk factors of PTLDs. The criteria of grouping included the presence of PTLDs, type of graft, medications for pre-transplant immunoreduction, pre-transplant recipient Epsein-Barr virus (EBV) serology. The parameters for analysis included the patients' demographic data, incidence of PTLDs and survival rate in each group.

Results:There were 138 males and 106 females with the mean age of 5.3 years old. The overall incidence of PTLDs 21.7%(53/244). The graft for the transplantation included ISB (n=96), LSB (n=109) and MV or MMV (n=39). With avaliable record of EBV PCR since 2001, almost all our patients with PTLDs were EBV related (25/26, 96.2%). In addition, the incidence of PTLDs  increased significantly with the increase of patients' age at operation. However, the use of thymoglobulin for pre-transplant immunoreduction could significantly reduce the incidence of PTLDs and improved both one year and five years survival rate. There was no significant relationship between the incidence of PTLDs to the gender of patient, type of graft, pre-transplant recipient EBV serology and donor EBV serology.

Conclusion: EBV infection and increased patient's age at transplant are risk factors of PTLDs in the children post intestinal transplant. Besides, optimal use of thymoglobulin for pre-transplant immunoredution could reduce the risk of PTLDs and improve the outcome after intestinal transplantation in our series. However, large prospective randomized studies are needed for the further identification of the risk factors between PTLDs and pediatric intestinal transplantation.    

[1] Nassif S., Kaufman S. et al Clinicopathologic features of post-transplantlymphoproliferative disorders arising after pediatric small bowel transplant.Pediatr Transplant. 2013 Dec;17(8):765-73.
[2] Ramos E., Hernández F. et al Post-transplant lymphoproliferative disorders and other malignancies after pediatric intestinal transplantation: incidence, clinical features and outcome.Transplant.2013 Aug;17(5):472-8.
[3] Perry AM., Aoun P. et al Early onset, EBV(-) PTLD in pediatric liver-small bowel transplantation recipients: a spectrum of plasma cell neoplasms with favorable prognosis. Blood . 2013 Feb 21;121(8):1377-83.
[4] Quintini C., Kato T. et al Analysis of risk factors for the development of posttransplant lymphoprolipherative disorder among 119 children who received primary intestinal transplants at a single center.Transplant Proc. 2006 Jul-Aug;38(6):1755-8.
[5] Müller AR., Pascher A. et al Small bowel transplantation - current status and initial .Zentralbl Chir. 2003 Oct;128(10):849-55.
[6] Green M., Bueno J. et al Predictive negative value of persistent low Epstein-Barr virus viral load after intestinal transplantation in children.Transplantation. 2000 Aug 27;70(4):593-6.
[7] Finn L., Reyes J. et al Epstein-Barr virus infections in children after transplantation of the small intestine. Am J Surg Pathol. 1998 Mar;22(3):299-309.
[8] Kocoshis SA. Small bowel transplantation in infants and children. Gastroenterol Clin North Am. 1994 Dec;23(4):727-42.


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