scholarly journals Post-Transplant Lymphoproliferative Disorder after Liver Transplant in the Pediatric Population: A Systematic Review

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 38-39
Author(s):  
Mobeen Zaka Haider ◽  
Zarlakhta Zamani ◽  
Muhammad Taqi ◽  
Hasan Mahmood Mirza ◽  
Yousra Khalid ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Liver Transplant ◽  
Immunosuppressive Therapy ◽  
Organ Transplantation ◽  
Graft Rejection ◽  
Pediatric Population ◽  
Stage Iv ◽  
Immunosuppressive Drugs ◽  
Response To Therapy ◽  
Post Transplant

Background: Post-transplant lymphoproliferative disease (PTLD), a group of lymphoid disorders ranging from indolent polyclonal proliferation to aggressive lymphomas is a known complication following solid organ transplantation. The aim is to study the characteristics, predictive factors, management, and outcomes of PTLD among pediatric groups after liver transplantation in particular. Methods: Following the PRISMA guideline, we performed a comprehensive literature search on PubMed, Cochrane Library, Embase, and clinicaltrials.gov from the past ten years on May 04, 2020. We used the MeSH terms of organ transplantation and lymphoproliferative disorders. Initial search revealed 1741 articles. We excluded all case reports, case series, pre-clinical trials, review articles, and meta-analysis. We found five retrospectives observational, one observational cohort study, and one multicenter cohort in the pediatric population. We extracted the data for baseline characteristics, the reason for transplantation, recipient & donor EBV status, immunosuppression used, type & stage of PTLD, organ system involved, duration between transplant and PTLD diagnosis, treatment, response to therapy, adverse effects of therapy and mortality. Results: We included seven retrospective observational studies with a total (n) number of 3116 post-liver transplant pediatric patients, out of which 135 (4.33%) patients who developed PTLD as a complication of transplantation were studied. The male to female ratio was 41: 55 with the gender of 6 patients unknown. In five studies, with 118 PTLD patients, 34 recipients and 24 donors were positive for EBV at the time of liver transplantation. In addition to EBV, CMV status of patients in 5 studies showed 11/25 (44%) PTLD patients positive for CMV at the time of transplant. Post-transplant immunosuppression was achieved among these seven cohorts with cyclosporine, tacrolimus, OKT3, mycophenolate mofetil, prednisone, and basiliximab. The diagnosis was made via biopsy, showing all histopathological types including early lesions 14/46 (30.4%), polymorphic 13/46 (28.3%), monomorphic 18/46 (39.1%), and classic Hodgkin's lymphoma PTLD 1/46 (2.1%). Diffuse large B-cell lymphoma was the most common subtype in 6/18 (33.3%) of samples with monomorphic PTLD. Hsu, et al. in their study showed a five-year survival rate of 33.3% for St. Jude's classification stage IV lymphoma compared to 88.9% for stage I-III. The median age for 36 patients from three studies at the diagnosis of PTLD was 39.6 months (range 24-48 months). The median duration from transplantation to the diagnosis of PTLD was 13.48 months (range 8-24 months) in 54 patients from four studies. PTLD treatment was achieved with a combination of reduction or withdrawal of the immunosuppressive drugs with antiviral prophylaxis, chemotherapy, irradiation & the use of monoclonal antibodies in a total of 57 PTLD patients for which post-transplant immunosuppression data was available. Study by Hsu, et al. reported that 5/16 (31.3%) patients had acute graft rejection and 2 had a chronic rejection in a group of 16 PTLD patients undergoing treatment for PTLD with a reduction in immunosuppressive therapy. The overall mortality in patients who developed PTLD was 15/54 (27.8%) in four of the studies. Conclusions: Pre-transplant EBV-naive status in patients was associated with a higher incidence of PTLD. Advanced stage (Stage IV) lymphoma was associated with poor survival outcomes. Monomorphic histopathology may be most commonly associated with PTLD post-liver transplant. The main approach for the treatment of PTLD is the reduction or complete withdrawal of immunosuppressive drugs, administration of antiviral drugs (ganciclovir/valganciclovir),and lymphoma treatment with chemotherapy or irradiation, and monoclonal antibody therapy such as rituximab. Management of PTLD with reduction or withdrawal of post-transplant immunosuppressive drugs in one cohort was associated with an increased risk of graft rejection. Thus immunosuppressive therapy maintaining a fine balance between the risk of graft rejection and risk of developing PTLD may be associated with better patient outcomes post-liver transplant. Disclosures Anwer: Incyte, Seattle Genetics, Acetylon Pharmaceuticals, AbbVie Pharma, Astellas Pharma, Celegene, Millennium Pharmaceuticals.: Honoraria, Research Funding, Speakers Bureau.

Post-Transplant Lymphoproliferative Disorder after Liver Transplant: A Systematic Review

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 34-35
Author(s):  
Mobeen Zaka Haider ◽  
Zarlakhta Zamani ◽  
Hafsa Shahid ◽  
Muhammad Taqi ◽  
Zahoor Ahmed ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Liver Transplant ◽  
Hodgkin Lymphoma ◽  
Organ Transplantation ◽  
Median Duration ◽  
Pediatric Population ◽  
Adult Population ◽  
Response To Therapy ◽  
Cochrane Library ◽  
Post Transplant

Background: Post-transplant lymphoproliferative disease (PTLD), a group of lymphoid disorders ranging from indolent polyclonal proliferation to aggressive lymphomas is a known complication following solid organ transplantation. The aim is to study the incidence, characteristics, predictive factors, management, and outcomes of PTLD after liver transplantation in particular. Methods: Following the PRISMA guideline, we performed a comprehensive literature search on PubMed, Cochrane Library, Embase, and clinicaltrials.gov from the past ten years on May 04, 2020. We used the MeSH terms of organ transplantation and lymphoproliferative disorders. The initial search revealed 1741 articles. We excluded all case reports, case series, pre-clinical trials, review articles, and meta-analysis. We found fifteen studies including retrospective observational and cohort studies. We extracted the data for baseline characteristics, the reason for transplantation, recipient & donor EBV status, immunosuppression used, type & stage of PTLD, organ system involved, duration between transplant and PTLD diagnosis, treatment, response to therapy, adverse effects of therapy and mortality. Results: We included 15 studies with a total (n) of 10706 post-liver transplant patients. 294 (2.74%) patients developed PTLD as a complication, out of which 104 (35.3%) were males, 106 (36%) females, and 84 unknowns. Table 1. The incidence of PTLD in the pediatric group was 135/3116 (4.3%) whereas in the adult population it was 115/7545 (1.5%). Data from eleven studies show that out of 202 participants, 67 recipients were positive, 39 negative, and 18 donors positive for EBV infection at the time of transplant. Data on the EBV serostatus for the remaining 106 recipients was not known at the time of transplant. Data from two studies showed that 25/29 patients who later developed PTLD were seronegative for EBV prior to the transplant and 26/29 were reported to undergo seroconversion partly due to transplantation with EBV positive donors (7/13). Post-transplant immunosuppression was achieved with cyclosporine, tacrolimus, azathioprine, mycophenolate mofetil, sirolimus, prednisone, OKT3 for acute cellular rejection and induction with monoclonal antibodies. Data from four studies conclude the median age at the time of PTLD diagnosis is 47.6 months in the pediatric population while 54 years in adults, overall ranging from 1 year to 73 years. Ten studies show the overall median duration from organ transplant to the diagnosis of PTLD is 23.5 months. The median duration for the pediatric population was 11.6 months from the data collected from 55 patients whereas five studies with 166 adult liver transplant recipients showed a median duration of 35.5 months. Histopathological types were diagnosed via biopsy samples, with monomorphic in 76 (25.8%), early lesions in 22 (7.4%), polymorphic in 19 (6.4%), and classic Hodgkin lymphoma like PTLD in 8 (2.7%) of the samples. Among the monomorphic type, Diffuse Large B-Cell Lymphoma (DLBCL) was the most commonly reported i.e. 10/50 (20%) of patients with monomorphic type in two studies. Treatment of PTLD consisted of reduction or cessation of the post-transplant immunosuppressive drugs, anti-CD20 antibody (rituximab), antiviral treatment with ganciclovir, and lymphoma treated with chemotherapy, radiotherapy, and surgical resection. Data from eight studies show a mortality rate of 61/214 (28.5%) with Huang, et al. reporting ¾(75%) of total deaths due to PTLD progression. Two studies report an overall survival rate of 26/32 (81.3%) and five-year survival of 15/41 (36.6%). Conclusions: Our analysis shows the incidence of PTLD after liver transplant is low with no significant gender predominance but a difference in the incidence was observed with significantly higher rates in the pediatric group as compared to the adult population. The most common biopsy proved histopathological type was monomorphic, with the least common type being Hodgkin lymphoma like PTLD. Among the monomorphic, DLBCL was the most common subtype. After liver transplantation, the development of PTLD is observed earlier in pediatric patients in comparison to adult recipients. EBV naive patients prior to liver transplantation are at higher risk for seroconversion post-transplant if transplanted with EBV positive donors and hence at increased risk of PTLD development. Disclosures Anwer: Incyte, Seattle Genetics, Acetylon Pharmaceuticals, AbbVie Pharma, Astellas Pharma, Celegene, Millennium Pharmaceuticals.: Honoraria, Research Funding, Speakers Bureau.

scholarly journals A case of rhabdomyolysis after atorvastatin therapy of a liver transplant recipient receiving immunosuppressive therapy with cyclosporine

2021 ◽  
Vol 13 (2) ◽  
pp. 158-164
Author(s):  
A. V. Shabunin ◽  
S. P. Loginov ◽  
P. A. Drozdov ◽  
I. V. Nesterenko ◽  
D. A. Makeev ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Drug Interactions ◽  
Liver Transplant ◽  
Immunosuppressive Therapy ◽  
Organ Transplantation ◽  
Muscle Pain ◽  
Solid Organ Transplantation ◽  
Solid Organ ◽  
Term Survival

Rationale. To date, liver transplantation is the most effective method of treating end-stage liver failure, and therefore this treatment has become widespread throughout the world. However, due to the improvement in the quality of transplant care and an increase in the long-term survival of patients, the development of concomitant pathology, which often requires medical treatment, is inevitably associated with a higher life expectancy of liver transplant recipients. Thus, in patients who underwent liver transplantation, there is. a significant increase in the incidence of dyslipidemia. However, a long-term immunosuppressive therapy in organ transplant patients can adversely modify the effect of the prescribed drugs, which requires careful monitoring and consideration of drug interactions.Purpose. Using a clinical example to demonstrate the importance of taking drug interactions into account in the treatment of patients after organ transplantation receiving immunosuppressive drugs.Material and methods. In the presented clinical case, a patient after orthotopic liver transplantation performed in 2005 underwent a staged treatment of cicatricial stricture of choledochal anastomosis in the S.P. Botkin City Clinical Hospital. During the following hospitalization, the patient complained of minor muscle pain when walking. At doctor's visit 3 weeks before hospitalization, a local physician prescribed therapy with atorvastatin 10 mg per day due to an increase in blood plasma cholesterol levels. The patient underwent removal of the self-expanding nitinol stent. During the follow-up examination, the patient had no evidence of an impaired bile outflow, however, muscle pain and weakness progressively increased, the rate of diuresis decreased, and in the biochemical analysis of blood there was an abrupt increase in the concentration of creatinine, aspartate aminotransferase, alanine aminotransferase. Atorvastatin was canceled, a diagnosis of acute non-traumatic rhabdomyolysis was established, treatment with hemodialysis and plasma exchange was started on 03/05/2020. The last session of renal replacement therapy was 03/30/20.Results. With the restoration of the diuresis rate, there was a spontaneous decrease in the level of creatinine to 170 μmol/L. The patient was discharged with satisfactory renal and hepatic function. The pain syndrome completely resolved. Conclusion. Drug interactions between atorvastatin and cyclosporine have resulted in acute rhabdomyolysis with life-threatening consequences. This once again confirms the importance of taking drug interactions into account when managing patients after solid organ transplantation.

A systematic review of post-transplant lymphoproliferative disorder after liver transplant.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e19045-e19045
Author(s):  
Mobeen Zaka Haider ◽  
Zarlakhta Zamani ◽  
Hasan Mehmood Mirza ◽  
Hafsa Shahid ◽  
Muhammad Taqi ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Liver Transplant ◽  
Lymphoproliferative Disorder ◽  
Clinical Presentation ◽  
Immunosuppressive Drugs ◽  
Common Type ◽  
Mortality Data ◽  
Cell Type ◽  
Post Transplant ◽  
Abdominal Symptoms

e19045 Background: Post-transplant lymphoproliferative disorder (PTLD) is a complication after liver transplantation. This study aims to explore the association of PTLD with the immunosuppression, types of PTLD, clinical presentation, and outcomes. Methods: Following the PRISMA guideline, we searched the literature on PubMed, Cochrane, Embase, and clinicaltrials.gov. 1741 articles were screened and 22 studies were included. Results: Data includes 22,235 total patients who underwent a liver transplant, and 449 (2.0%) patients who developed PTLD were studied. Of the 394 patients where gender was reported, 226 were male and 168 were female. Post-transplant EBV status was positive for 63/115 (56%). 11 studies showed that the median time from transplant to the development of PTLD was 33.4 months. Among the histological types of PTLD, the monomorphic B-cell was the most common type with 127/235 (54%) cases, followed by early lesions 25/235, polymorphic 24/235, Hodgkin lymphoma 8/235, and monomorphic T-cell type 7/235. Treatment of PTLD involved reduction or cessation of the immunosuppressive drugs along with chemotherapy surgery and radiotherapy. Mortality data from 13 studies showed 68/259 (31.3%) patients died either due to PTLD or its complication. Conclusions: PTLD is rare but associated with high mortality after liver transplantation. EBV seropositivity is associated with PTLD in the majority of cases. Monomorphic PTLD is the most common type of PTLD after liver transplantation with DLBCL being the most common subtype. Abdominal symptoms and fever are among the most common symptoms. PTLD after Liver transplant a review of studies. [Table: see text]

scholarly journals Risk factors predicting Cytomegalovirus infection in post liver transplant recipients

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
M G Abdelrahman ◽  
H A Mahmoud ◽  
M K Mohsen ◽  
M O Ali ◽  
A M N Mohamed
Keyword(s):  
Risk Factors ◽  
Liver Transplantation ◽  
Liver Transplant ◽  
Organ Transplantation ◽  
Chronic Rejection ◽  
Cytomegalovirus Infection ◽  
Transplant Recipients ◽  
Cmv Infection ◽  
Donor Liver Transplantation ◽  
Liver Transplant Recipients

Abstract Background Liver transplantation is considered to be the only curative treatment for patients with end stage liver disease. Postoperative infection remains to be one of the most common causes of morbidity and mortality throughout the past years. Cytomegalovirus (CMV) infection although considered to be a weak viral infection that usually passes asymptomatic in immunocompetent patients, however, it is considered one of the most common pathogens causing morbidities and mortality in liver transplant recipients. Multiple studies have been done to assess the risk factors for developing CMV infection. Objective Identification of risk factors predicting Cytomegalovirus infection in liver transplant recipients following transplantation. Methods This retrospective study was conducted on 194 patients and their donors who underwent living donor liver transplantation operation at Ain Shams centre for organ transplantation (ASCOT) at Ain Shams specialized hospital in the period between January 2010 and December 2016 with at least one year follow up period after operation for the recipient group. Results In our study, 194 patients undergoing liver transplantation at Ain shams centre for organ transplantation over seven years from January 2010 to December 2016 have been followed to assess risk factors affecting CMV infection development. Chronic rejection was found to be the most common factor associated with CMV infection followed by Cyclosporin (Neoral) as main postoperative immunosuppressant following liver transplantation. Other factors that were found to carry risk for CMV infection included younger age, advanced MELD score, positive CMV IgM status of the donors and recipients. Conclusion Differentiation of Cytomegalovirus disease from Cytomegalovirus infection isn’t always available as it requires tissue invasive techniques. Multiple risk factors have been attributed to cause Cytomegalovirus infection (viremia) . In our study, rejection (chronic rejection) was the factor that carries highest risk for Cytomegalovirus infection development followed by Cyclosporin .

scholarly journals Th1/Th2cytokines and ICAM–1 levels post-liver transplant do not predict early rejection

2000 ◽  
Vol 9 (1) ◽  
pp. 35-38 ◽  
Author(s):  
E. Granot ◽  
A. Tarcsafalvi ◽  
S. Emre ◽  
P. Sheiner ◽  
S. Guy ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Liver Transplant ◽  
Immunosuppressive Therapy ◽  
Allograft Rejection ◽  
Liver Perfusion ◽  
Percentage Increase ◽  
Plasma Samples ◽  
Liver Allograft ◽  
Predominant Factor ◽  
Ifn Γ

Th1derived cytokines IFN-γ and IL–2, Th2cytokine IL–4, and ICAM–1 have been implicated in liver allograft rejection. In order to determine whether monitoring of cytokine profiles during the first days post-liver transplant can predict early rejection we measured IFN-gg, IL–2, sIL–2 receptor, IL–4 and ICAM–1 in 22 patients, in plasma samples obtained within 4h after liver perfusion (baseline) and between postoperative days (POD) 3–6. ICAM–1 and sIL–2R levels at POD 3–6 were significantly higher than at baseline but did not differ in presence or absence of rejection. Mean percentage increase of ICAM–1 levels was significantly lower in patients with Muromonab-C3Orthoclone OKT3(J.C. Health Care) (OKT3) whereas percentage increase of sIL–2R levels was higher in OKT3-treated patients. IFN-γ levels at POD 3–6 increased from baseline while IL–4 levels were unchanged. Levels of IFN-γ, IL–4 and their ratios did not correlate with rejection or immunosuppressive therapy. Thus, Th1/Th2cytokine monitoring during the first week post-transplant does not predict early rejection and immunosuppressive therapy is the predominant factor affecting ICAM and sIL–2R levels after liver transplantation.

Pediatric Liver Transplantation

2018 ◽  
Author(s):  
Jonathon Nelson ◽  
Franklyn P. Cladis
Keyword(s):  
Liver Transplantation ◽  
Liver Transplant ◽  
Pediatric Patient ◽  
Hepatic Failure ◽  
Pediatric Population ◽  
Donor Pool ◽  
Pediatric Pathology ◽  
Intraoperative Management ◽  
Immunosuppressant Medications ◽  
The 1960S

Liver transplantation has become a standard surgical treatment for pediatric patients with hepatic failure, tumors, and metabolic derangements. Liver transplantation in the pediatric population can be extremely challenging for the anesthesiologist due to multiple perioperative considerations. The first successful liver transplant was performed in a pediatric patient in the 1960s, and since then, there have been significant advances in immunosuppressant medications and preservation solutions which have led to improved survival. Nevertheless, the number of liver transplants continues to be limited by organ availability, although the pediatric donor pool has been increased by living related donors and split livers. The most common pediatric pathology that results in hepatic failure and transplantation is biliary atresia. This chapter covers the perioperative care of a pediatric patient undergoing a liver transplant, from the preoperative preparation to the intraoperative management, and discusses postoperative challenges which may be encountered while in the intensive care unit.

scholarly journals THE OPPORTUNITIES OF NON-INVASIVE LIVER GRAFT REJECTION DIAGNOSTICS BY USING TERMINALLY DIFFERENTIATED EFFECTOR CD8+ T-LYMPHOCYTES

2020 ◽  
Vol 4 (2) ◽  
pp. 177-183
Author(s):  
S. V. Korotkov ◽  
◽  
V. N. Smolnikova ◽  
V. Y. Hrynevich ◽  
O. A. Lebed ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
T Lymphocytes ◽  
Graft Rejection ◽  
Absolute Number ◽  
Liver Graft ◽  
Noninvasive Method ◽  
Graft Dysfunction ◽  
Post Transplant ◽  
Cd8 T Lymphocytes ◽  
Immune Mediated

Background. Immune-mediated graft dysfunction with the prevalence of 40% is one of the main problems of modern transplantology. Although percutaneous liver graft biopsy is associated with the development of different complications occurring in 2,2% of cases and can also lead to fatal outcome. Objective – to develop a noninvasive method of graft dysfunction diagnostics in the late post-transplant period using terminally differentiated effector CD8+ T-lymphocytes. Material and methods. There was carried out a single center observational retrospective case-control pilot study, including 45 recipients after orthotopic liver transplantation. According to the postoperative clinical course the patients were stratifed into 2 groups depending on the presence of graft rejection episodes. All patients got immunosuppressive therapy after liver transplantation. Immunophenotypes of the recipients were determined by flow cytometry method. Percutaneous liver graft biopsy was performed in all patients, the results of histological examination were evaluated according to the international Banff schema for grading liver allograft rejection. Results. The results of liver biopsies showed that 14 (31%) out of 45 patients had morphological signs of rejection. The patients with rejection had a reliably higher level of CD8+ Temra cells absolute number (0,23 (0,14;0,38) x 109/l) in comparison to those without rejection (0,09) (0,034;0,16) x 109/l (p=0,034)). The results of ROC-analysis have shown that the most optimal cut-off threshold of CD8+ T-lymphocytes level in immune-mediated graft dysfunction diagnostics in the late post-transplant period is 0,1882x109/l; sensitivity and specifcity in this case being 73,33 (95%; 44,9-92,0) and 96,55 (95%; 82,2-99,4) respectively. Conclusions. The increase of terminally differentiated effector CD8+ T-lymphocytes absolute number has diagnostic importance in patients with immune-mediated graft dysfunction in the late post-transplant period. High sensitivity and specifcity of cut-off threshold of CD8+ Temra lymphocytes absolute number in patients after liver transplantation as well as reliable difference between cell number in patients with normal postoperative period and in patients with immune-mediated graft dysfunction allow considering T-lymphocyte subpopulation as a rejection predictor in the late post-transplant period. The correlation between CD8+ T-lymphocyte absolute number and the results of histological examination makes the former an alternative and, what is more, safe noninvasive method in early diagnostics of liver graft rejection.

scholarly journals Management of COVID-19 in Liver Transplant Recipients with Immunosuppressant Therapy: Experiences of an Iranian Transplant Registry

2020 ◽  
Author(s):  
Zahra Sheikhalipour ◽  
Touraj Asvadi kermani ◽  
Farzad Kakaei ◽  
Azizeh Farshbaf Khalili ◽  
Leila Vahedi
Keyword(s):  
Liver Transplantation ◽  
Liver Transplant ◽  
Organ Transplant ◽  
Immunosuppressive Drugs ◽  
Personal Hygiene ◽  
Transplant Recipients ◽  
Liver Transplants ◽  
Transplant Registry ◽  
Use Of Medical Services ◽  
Liver Transplant Recipients

Abstract Background: Following the pandemic of COVID-19 and the increased COVID-19 risk in transplant patient receptions, the authors assessed the prevalence, clinical course, and the outcome of the COVID-19 infection among liver transplant receptions. Methods: By designing and the use of researcher made questionnaire and the use of medical services, liver transplantation recipients under our center surveyed in terms of COVID-19 infection.Results: Seven patients infected with COVID-19 were identified from 265 liver transplantation recipients. The majority of patients were male and had COVID-19 despite being in-home quarantine. All patients received immunosuppressive drugs during infection with COVID-19 with no change in the routine immunosuppressive therapy. Among the identified patients, 5 recovered and 2 died. One of the dead patients, in addition to having a liver transplant, suffered brain cancer with metastasis to the lungs. Conclusion: It seems that the in liver transplants infected with COVID-19, the immunosuppressive drugs causes mild to moderate illness, and even recover from the disease.However, more evidence is needed to prove this hypothesis. It is also recommended that transplant recipients should be warned about personal hygiene and closely be monitored by organ transplant centers.

Post-transplant lymphoproliferative disorder (PTLD) after liver transplantation: Report of 16 cases from a single center.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e19513-e19513
Author(s):  
Ayhan Ulusakarya ◽  
Beatrice Delmas Marsalet ◽  
Srimanta Misra ◽  
Nahla Cucherousset ◽  
Philippe Ichai ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Complete Remission ◽  
Liver Transplant ◽  
Rare Complication ◽  
Transplant Rejection ◽  
Immunosuppressive Treatment ◽  
Stage Iv ◽  
University Hospital ◽  
Standard Regimen ◽  
Poor General Health

e19513 Background: PTLD is a rare complication of organ transplantation, but it can jeopardize the transplantation outcome. Methods: Paul Brousse University Hospital is the largest liver transplantation center in France. We retrospectively analyzed data from all of the patients who experienced PTLD and treated in our hematology/oncology department in the last 10 years. Results: 16 cases of PTLD occurred after various intervals following the liver transplant without correlation with the type of underlying liver disease or immunosuppressive treatment. Overall, the patients had poor general health (ECOG 3-4: 69%), renal and/or hepatic failure (75%), and cytopenia (63%). PTLD were often of high grade (81%), B phenotype (94%), stage IV (75%), with high LDH (88%). The most frequent disease sites were liver (63%), subdiaphragmatic lymphadenopathy (69%), and extranodal (69%). After a reduction in the immunosuppressive treatment, the patients received their initial chemotherapy mostly with a combination of prednisolone, cyclophosphamide, vincristine, and rituximab. As soon as their general condition improved, R-CHOP was given as the standard regimen. All patients experienced severe and frequent complications during chemotherapy. Two patients had liver transplant rejection, lethal in one case. Six patients died: 4 of progression or relapse of PTLD, one after 4th liver transplantation, one of leukoencephalitis. Complete remission was obtained in 81% of patients. Ten patients (63%) are alive in complete remission after a median follow up of 6.5 years. Conclusions: Despite the clinical complexity of these patients, PTLD can be treated utilizing common lymphoma chemotherapy with treatment accommodations to poor ECOG, liver and renal dysfunctions.

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