2342. Post-transplant Lymphoproliferative Disorder in Pediatric Patients: Clinical Sites of Occurrence and Related Survival Rates.
Session: Poster Abstract Session: Transplant Virology
Saturday, October 29, 2016
Room: Poster Hall
Posters
  • IDweek2016-20161012.pdf (3.4 MB)
  • Background: Post-transplant lymphoproliferative disorder (PTLD) is a devastating complication of organ transplantation. The majority of cases are associated with the Epstein-Barr virus (EBV). The factors influencing mortality are variable. The aim of the study was to review trends in PTLD rates, the sites of involvement on presentation and the associated survival rates.

    Methods: In a hospital-based PTLD registry, we identified biopsy-proven cases of PTLD among children < 18 years of age over a 15-years period (2000-2014). Cases that were included had at least 1 year of follow-up after the initial diagnosis of PTLD. Recurrent cases of PTLD were excluded.

    Results: Eighty-two patients with a first episode of PTLD were included. Median age at diagnosis was 6.4 years (interquartile range (IQR) 3.2-12.3). Median time post-transplantation at diagnosis of PTLD was 1.44 years (IQR 0.5-4.2). With respect to number of PTLD cases occurring as a proportion of patients transplanted, the frequency of PTLD was highest in multi-organ transplant recipients (32%), followed by lung (20%) and heart recipients (14%). PTLD was less common among liver (9%) and kidney transplant recipients (5%). The most frequent PTLD sites were tonsillar/adenoidal (T/A, 34%), gastrointestinal (GI) tract (32%), lymph node (11%) and multi-site (11%). Mortality at 1 year was lower in cases of T/A PTLD (1/28, 3.6%) compared with PTLD at other sites (13/54, 24.1%; P=.028). At 5 years, the difference remained significant (2/17, 11.8% vs 22/46, 47.8%; P=.01). When compared with T/A PTLD, lymph node PTLD was associated with a higher mortality at 1 year (4/9, 44.4%; P=.008) and 5 years (5/9, 55.5%; P=.028). Similarly, multi-site PTLD was associated with increased mortality at 5 years (5/9, 55.5%; P=.028) compared with T/A PTLD. With respect to the transplanted organ, lung transplant patients had a higher all-cause mortality (4/9, 44.4%) than other transplant patients (10/73, 13.7%; P=.042) at 1 year after the diagnosis of PTLD. This remained significant at 5 yrs (7/9, 77.8% vs 17/54, 31.5%; P=.021).

    Conclusion: Among first episodes of PTLD, T/A and GI sites accounted for the majority of cases. T/A PTLD was associated with a survival advantage when compared with PTLD located at other sites. There are potential clinical, virologic or other reasons for these findings, which require further study.

    Arnaud G. L'huillier, MD, Anne Dipchand, MD, Vicky Ng, MD, Dianne Hebert, MD, Yaron Avitzur, MD, Melinda Solomon, MD, Simon Yeung, HBSc and Upton D. Allen, MD, MSc, The Hospital for Sick Children, Toronto, ON, Canada

    Disclosures:

    A. G. L'huillier, None

    A. Dipchand, None

    V. Ng, None

    D. Hebert, None

    Y. Avitzur, None

    M. Solomon, None

    S. Yeung, None

    U. D. Allen, None

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