The effect of immunosuppression on posttransplant lymphoproliferative disease in pediatric transplant patients

B. S. Younes, S. V. McDiarmid, M. G. Martin, J. H. Vargas, J. A. Goss, R. W. Busuttil, M. E. Ament

Research output: Contribution to journalArticlepeer-review

136 Scopus citations


Background. Posttransplant lymphoproliferative disease (PTLD) is a serious complication associated with the use of chronic immunosuppression for solid organ transplantation. This study represents a retrospective analysis of UCLA's experience with PTLD in all pediatric liver transplant recipients between 1984-1997. We assessed the clinical presentation, risk factors, incidence density, immunological characteristics, management, and outcome of patients who developed PTLD when receiving either primary cyclosporin A (CsA) or tacrolimus. Methods. A total of 251 children received primary CsA therapy of which 70 required OKT3 for steroid resistant rejection and 29 required tacrolimus rescue for OKT3 resistance and/or chronic rejection. One hundred forty one children received tacrolimus as primary therapy. Sixty patients who survived for less than 6 months after transplantation were excluded from the study. Results. The total incidence density (ID) rate of PTLD was 1.8±0.4 per 100 patient-years (30/392). The overall ID rate of PTLD in the CsA group was 0.93±0.2 per 100 patient-years (15/251). Within this group of primary CsA-treated patients, the ID rate of PTLD was 0.49±.01 without OKT3 or tacrolimus, 0.67±0.2 with OKT3, and 6.42±1.1 with tacrolimus rescue. The over-all PTLD ID rate in the primary tacrolimus-treated patients was 4.86±1.2 per 100 person-years (15/141). There was a 5-fold increase in the ID rate of PTLD in the primary tacrolimus group when compared to the comparable, primary CsA group (P<0.001). The mean time to PTLD was 5-fold longer (49.7±20.7 months) in the CsA group when compared to the CsA/tacrolimus rescue group (9.8±3 months, P<0.05) or the tacrolimus primary group (12.6±5.1 months, P<0.05). Five patients had monoclonal disease in the CsA group, but only one in the tacrolimus group (P<0.05). Clinical presentations with enlarged lymph nodes, fevers, malaise, anorexia, weight loss, hypoalbuminemia, and gastrointestinal blood loss were common, Mortality was 20%, three patients died in each group. Conclusion. The use of primary tacrolimus therapy was associated with a significant 5-fold higher rate of PTLD when compared to those treated with primary cyclosporine. Early diagnosis, decrease and/or discontinuation of potent immunosuppressive agents may contribute to decrease morbidity and mortality of this entity.

Original languageEnglish (US)
Pages (from-to)94-99
Number of pages6
Issue number1
StatePublished - Jul 15 2000

ASJC Scopus subject areas

  • Transplantation


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