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Long-Term Evaluation of Post-transplant Lymphoproliferative Disorders in Paediatric Heart Transplantation in Sao Paulo, Brazil

  • Adam ArshadEmail author
  • Estela Azeka
  • Samia Barbar
  • Raphael Marcondes
  • Adailson Siqueira
  • Luiz Benvenuti
  • Nana Miura
  • Marcelo Jatene
  • Vicente Odone Filho
Original Article

Abstract

We sought to better define the demographics and characteristics of post-transplant lymphoproliferative disorders (PTLD) in a cohort of paediatric OHT patients from a developing country. Data were collected from the Heart Institute, Sao Paulo, for all paediatric OHT recipients from October 1992 to October 2018. Group differences between the PTLD and non-PTLD cohorts were assessed by Fisher exact and Mann–Whitney U tests. Kaplan–Meier curves analysed the survival in each group. Data were reviewed for 202 paediatric OHT recipients. Overall 1-, 5- and 10-year survival for the entire cohort was 76.5%, 68.3% and 62.9%; 24 patients (11.9%) developed PTLD at a median 3.1 years (IQR 0.8–9.0) after OHT. Cases were evenly spread over the follow-up period, with PTLD diagnosed in 9.8% (n = 137) of patients who were alive at 3 years, 15.3% (n = 78) of patients who were alive at 5 years and 29.3% (n = 41) of patients who were alive at 10 years. The commonest form of PTLD was diffuse large B cell lymphoma (n = 9), and most patients received rituximab with immunosuppression and chemotherapy as treatment (n = 15). We identified no increased risk in mortality amongst the PTLD vs. non-PTLD cohorts in multivariate analysis (P = 0.365). PTLD after paediatric OHT had acceptable outcomes. However, risk factors for PTLD were not identified and warrant further investigation.

Keywords

Heart clinical Complications–heart clinical Paediatric transplantation 

Abbreviations

EBV

Epstein Barr virus

OHT

Orthotopic heart transplantation

PTLD

Post transplant lymphoproliferative disease

Notes

Acknowledgements

FAPESP (Fundação de Amparo a Pesquisa do Estado de Sao Paulo).

Author Contribution

Designed study EA, Data extraction EA, SB, RM, AS, LB, NM, MJ, VF, Data analysis AA, Data interpretation AA, EA, Wrote original draft AA, EA, Reviewed manuscript All authors

Funding

A public research foundation that provides grants to support research in Brazil. This funding source has had no role in the collection of data, its analysis, interpretation and the writing of this manuscript.

Compliance with Ethical Standards

Conflict of interest

The authors declare no conflicts of interest.

References

  1. 1.
    Boucek MM, Edwards LB, Keck BM, Trulock EP, Taylor DO, Mohacsi PJ et al (2003) The registry of the international society for heart and lung transplantation: sixth official pediatric report–2003. J Heart Lung Transpl 22(6):636–652CrossRefGoogle Scholar
  2. 2.
    Bernstein D, Baum D, Berry G, Dahl G, Weiss L, Starnes VA, et al. (1993) Neoplastic disorders after pediatric heart transplantation. Circulation 88(5 Pt 2):11230–11237.Google Scholar
  3. 3.
    Webber SA, Naftel DC, Fricker FJ, Olesnevich P, Blume ED, Addonizio L et al (2006) Lymphoproliferative disorders after paediatric heart transplantation: a multi-institutional study. Lancet 367(9506):233–239CrossRefGoogle Scholar
  4. 4.
    Schubert S, Abdul-Khaliq H, Lehmkuhl HB, Yegitbasi M, Reinke P, Kebelmann-Betzig C et al (2009) Diagnosis and treatment of post-transplantation lymphoproliferative disorder in pediatric heart transplant patients. Pediatr Transpl 13(1):54–62CrossRefGoogle Scholar
  5. 5.
    Green M, Michaels MG (2013) Epstein-Barr virus infection and posttransplant lymphoproliferative disorder. Am J Transpl 13(Suppl 3):41–54; quiz CrossRefGoogle Scholar
  6. 6.
    Allen UD, Preiksaitis JK (2013) Practice ASTIDCo. Epstein-Barr virus and posttransplant lymphoproliferative disorder in solid organ transplantation. Am J Transpl 13(Suppl 4):107–120.CrossRefGoogle Scholar
  7. 7.
    Petrara MR, Giunco S, Serraino D, Dolcetti R, De Rossi A (2015) Post-transplant lymphoproliferative disorders: from epidemiology to pathogenesis-driven treatment. Cancer Lett 369(1):37–44CrossRefGoogle Scholar
  8. 8.
    Mendoza F, Kunitake H, Laks H, Odim J (2006) Post-transplant lymphoproliferative disorder following pediatric heart transplantation. Pediatr Transpl 10(1):60–66CrossRefGoogle Scholar
  9. 9.
    Manlhiot C, Pollock-Barziv SM, Holmes C, Weitzman S, Allen U, Clarizia NA et al (2010) Post-transplant lymphoproliferative disorder in pediatric heart transplant recipients. J Heart Lung Transpl 29(6):648–657CrossRefGoogle Scholar
  10. 10.
    Hayes D Jr, Breuer CK, Horwitz EM, Yates AR, Tobias JD, Shinoka T (2015) Influence of posttransplant lymphoproliferative disorder on survival in children after heart transplantation. Pediatr Cardiol 36(8):1748–1753CrossRefGoogle Scholar
  11. 11.
    Chinnock R, Webber SA, Dipchand AI, Brown RN, George JF, Pediatric Heart Transplant S (2012) A 16-year multi-institutional study of the role of age and EBV status on PTLD incidence among pediatric heart transplant recipients. Am J Transpl 12(11):3061–3068.CrossRefGoogle Scholar
  12. 12.
    Lee HY, Oh BH (2017) Heart transplantation in Asia. Circ J 81(5):617–621CrossRefGoogle Scholar
  13. 13.
    Arvin A et al (2007) Human herpesviruses. Cambridge University Press, CambridgeCrossRefGoogle Scholar
  14. 14.
    Bocchi EA, Fiorelli A (2001) First guideline group for heart transplantation of the Brazilian society of C. The Brazilian experience with heart transplantation: a multicenter report. J Heart Lung Transpl 20(6):637–645.CrossRefGoogle Scholar
  15. 15.
    Rudge C, Matesanz R, Delmonico FL, Chapman J (2012) International practices of organ donation. Br J Anaesth 108(Suppl 1):i48–55CrossRefGoogle Scholar
  16. 16.
    Swerdlow SH, Campo E, Pileri SA, Harris NL, Stein H, Siebert R et al (2016) The 2016 revision of the World Health Organization classification of lymphoid neoplasms. Blood 127(20):2375–2390CrossRefGoogle Scholar
  17. 17.
    Gross TG, Orjuela MA, Perkins SL, Park JR, Lynch JC, Cairo MS et al (2012) Low-dose chemotherapy and rituximab for posttransplant lymphoproliferative disease (PTLD): a children's oncology group report. Am J Transpl 12(11):3069–3075CrossRefGoogle Scholar
  18. 18.
    Oertel SH, Verschuuren E, Reinke P, Zeidler K, Papp-Vary M, Babel N et al (2005) Effect of anti-CD 20 antibody rituximab in patients with post-transplant lymphoproliferative disorder (PTLD). Am J Transpl 5(12):2901–2906CrossRefGoogle Scholar
  19. 19.
    Lund LH, Khush KK, Cherikh WS, Goldfarb S, Kucheryavaya AY, Levvey BJ et al (2017) The registry of the international society for heart and lung transplantation: thirty-fourth adult heart transplantation report-2017; focus theme: allograft ischemic time. J Heart Lung Transpl 36(10):1037–1046CrossRefGoogle Scholar
  20. 20.
    Rossano JW, Dipchand AI, Edwards LB, Goldfarb S, Kucheryavaya AY, Levvey Rn BJ et al (2016) The registry of the international society for heart and lung transplantation: nineteenth pediatric heart transplantation report-2016; focus theme: primary diagnostic indications for transplant. J Heart Lung Transpl 35(10):1185–1195CrossRefGoogle Scholar
  21. 21.
    Dipchand AI (2018) Current state of pediatric cardiac transplantation. Ann Cardiothorac Surg 7(1):31–55CrossRefGoogle Scholar
  22. 22.
    Azeka E, Jatene M, Galas FR, Tanamati C, Penha J, Benvenuti L et al (2014) Heart transplantation in pediatric population and in adults with congenital heart disease: long-term follow-up, critical clinical analysis, and perspective for the future. Transpl Proc 46(6):1842–1844CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.College of Medical and Dental SciencesUniversity of BirminghamBirminghamUK
  2. 2.Heart Institute (InCor), University of São Paulo Medical SchoolSão PauloBrazil
  3. 3.Pediatric Oncology, University of São Paulo Medical SchoolSão PauloBrazil

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