Early Signs And Risk Factors For The Increased Incidence Of Epstein-Barr Virus-Related Posttransplant Lymphoproliferative Diseases In Pediatric Liver Transplant Recipients Treated With Tacrolimus.
Sokal, Etienne Marc 1; Antunes, Henedina; Beguin, Claire; Bodeus, Monique; Wallemacq, Pierre; de Goyet, Jean de Ville; Reding, Raymond; Janssen, Magda; Buts, Jean Paul; Otte, Jean Bernard
High-dose/activation-associated tolerance:a mechanism for allograft toleran. 64(10):1438-1442, November 27, 1997.
Background. Posttransplant lymphoproliferative disease (PTLD) is a life-threatening condition the incidence of which in pediatric solid organ transplantation may be related to the immunosuppressive load. It has been suggested that tacrolimus, a new and potent immunosuppressor, causes an increased incidence of this syndrome.
Methods. The incidence, early signs, and risk factors for lymphoproliferative disease were reviewed in a cohort of 89 pediatric liver transplant recipients treated with tacrolimus.
Results. Eighteen patients (20%) developed a PTLD-16 concomitant to a primary Epstein-Barr virus (EBV) infection and 2 with previous immunity against EBV. Three additional patients had preliminary signs of PTLD concomitant to primary EBV infection, but did not develop individualized lymphoid masses. Six patients died (6.7% of all tacrolimus-treated patients). Mean tacrolimus blood level during the 3 months preceding EBV infection reached 11.8 /-1.8 ng/ml in PTLD patients versus 9.4 /-3.4 ng/ml in non-PTLD patients(0.05
Conclusion. In EBV-infected pediatric liver transplant recipients, use of OKT3 or antithymocyte globulin and high tacrolimus blood levels are risk factors for a significant increase in the incidence of PTLD. An increase in total[gamma]-globulin level and appearance of mono/oligoclonal immunoglobulin production are the major preliminary signs of the syndrome.
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