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.