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, E.M.; Antunes, H.; Beguin, C.; Bodeus, M.; Wallemacq, P.; de Ville de Goyet, J.; Reding, R.; Janssen, M.; Buts, J.P.; Otte, J.B.
Transplantation 64(10): 1438-1442
1997
ISSN/ISBN: 0041-1337 PMID: 9392308 Document Number: 471377
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