Introduction
With the advancement in medical standards in recent years, children suffering from end-stage liver diseases, such as intrahepatic and extrahepatic cholestasis, metabolic diseases, acute liver failure, and liver tumors, can now undergo liver transplantation. Currently, liver transplantation is the only effective way to treat end-stage liver disease in children; highly-developed surgical techniques and the administration of immune-suppressants have significantly improved the overall survival rate of pediatric patients undergoing liver transplantation. The 5-year survival rate of pediatric patients undergoing liver transplantation in developed countries is as high as 80% 1. PTLD is a fatal complication that can occur in children following liver transplantation. Recently, the number of reported PTLD cases has generally increased. PTLD has various clinical manifestations and is difficult to identify at an early stage. The mortality rate of patients is as high as 30%–60%; thus, most patients have a poor prognosis. The incidence of PTLD after liver transplantation in children approximately ranges between 1% and 5%2,3,4, and PTLD is more frequently encountered in pediatric patients with a poor prognosis 5.
Epstein-Barr virus (EBV) infection is a reported risk factor associated with PTLD. EBV is one of the most frequently observed viral pathogens affecting pediatric patients undergoing liver transplant. According to previous reports, EBV infection is closely related to the incidence of PTLD 6. Similarly, studies have shown that tacrolimus is one of the risk factors in PTLD. The application of tacrolimus after transplantation is known to increase the incidence of malignant tumors and PTLD in patients 7,8,9; thus, the use of tacrolimus is an additional risk factor associated with PTLD in pediatric patients undergoing a liver transplant. Similarly, patient age at transplantation (between 1-10 years old) and the occurrence of acute rejection after transplantation are related to the occurrence of PTLD10,11.
The risk factors associated with PTLD after liver transplantation in European and North American pediatric patients have been reported in the literature. However, a similar study is currently lacking in the Chinese pediatric population. Here, we conducted a single-center retrospective study to investigate the risk factors of PTLD after liver transplantation in China.