Aim: Posttransplant lymphoproliferative disorder (PTLD) is a consequential complication following solid organ transplantation (SOT), particularly associated with the Epstein‐Barr virus (EBV). This study analyzes the experience of a single center in managing pediatric PTLD cases over a seven-year period. The investigation focuses on PTLD incidence rates, anatomical sites involved, and their correlation with clinical outcomes. The primary objective is to explore clinical features and treatment outcomes in pediatric PTLD patients, emphasizing patient survival and associated clinical ramifications.
Methods: Retrospective analysis of medical records from pediatric SOT recipients (liver and kidney) at Baskent University Ankara Hospital Organ Transplantation Center between January 1, 2017, and January 1, 2024. The study, approved by the Institutional Review Board (KA24/63), identified PTLD cases based on persistent lymphadenopathy or tumorous lesions, confirmed through pathological examination. Patient categorization distinguished between malignant and benign groups. Early PTLD was defined within the initial year post-transplantation. EBV association was determined through in situ hybridization, and patient characteristics were reviewed comprehensively.
Results: In a seven-year period, 10 pediatric patients (9 liver transplants, 1 kidney transplant) were diagnosed with PTLD, resulting in an incidence of 8.7% for pediatric liver transplants. The mean age at diagnosis was 46.4 months, and the mean time from transplantation to PTLD diagnosis was 21.2 months. The most common complaints at diagnosis included fever, lymphadenopathy, hepatosplenomegaly, dyspnea, and diarrhea. Treatment modalities included rituximab, immunosuppression reduction, intravenous immunoglobulin (IVIG) therapy, and chemotherapy (NHL-90). All patients achieved remission, with a mean follow-up period of 68.9 months.
Conclusion: The study highlights the importance of early PTLD diagnosis and the effectiveness of rituximab with immunosuppression reduction in achieving complete remission, particularly in early polymorphic cases. Despite the challenges, all patients achieved remission, signaling improved outcomes in managing pediatric PTLD. Active monitoring of EBV infection may further reduce PTLD complications in pediatric SOT, emphasizing the need for early diagnosis by clinicians.