Risk factors for post-transplant lymphoproliferative disorder after
pediatric liver transplantation
Abstract
Abstract Background: Post-transplant lymphoproliferative disorder (PTLD)
is a dangerous complication of liver transplantation. This study aimed
to analyze the risk factors associated with PTLD after liver
transplantation in children. Method: We retrospectively analyzed
collected clinical and laboratory data of patients treated and
followed-up at Shanghai Children’s Medical Center between January 2012
and January 2019. Twenty-four patients with PTLD were enrolled in this
study using a 1:2 pairing design. Each case was matched with two
controls who had undergone liver transplantation within the same year
and did not develop PTLD during the follow-up period. In total, 72
patients were included in this study. Result: No differences in age,
gender, weight, primary disease, or type of liver transplantation were
observed between those with and without PTLD. Graft weight, graft body
weight ratio, transplant type, intraoperative blood loss, blood type,
and CMV/EBV infection status of donors and recipients were not related
to the occurrence of PTLD. Univariate analysis demonstrated
statistically significant differences in EBV infection, tacrolimus blood
concentration, PTL, AST, ALT, and CHOL between those with and without
PTLD. Multivariate logistics regression analysis demonstrated that EBV
infection was an independent risk factor for PTLD. A close relationship
was observed between EBV-DNA peak time after transplantation and PTLD
onset time. Additionally, the higher the tacrolimus blood concentration,
the more difficult it was to control EBV infection. Conclusion: EBV
infection is an independent risk factor for PTLD. When uncontrolled
proliferation of EBV occurs after organ transplantation, the dosage of
immunosuppressive agents should be appropriately reduced