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Posttransplantation Lymphoproliferative Disorder (PTLD) in Liver and Small Bowel Transplant Recipients

  • Chapter
Post-Transplant Lymphoproliferative Disorders

Core Messages

  • The incidence, morbidity, and mortality of PTLD in liver and intestine transplantations have significantly decreased over time.

  • Incidence of PTLD in pediatric liver transplantation is currently 2–3%, and is approaching the 1–2% rate of PTLD seen after adult liver transplantation.

  • Improvements in immunosuppression, EBV monitoring, pre emptive therapy, and treatment have led to this reduction in incidence as well as to a concomitant reduction in mortality.

  • The incidence of PTLD in pediatric intestine transplantation has been dramatically reduced from historical rates of 30–40% to approximately 8–10%. PTLD occurs in approximately 13% of children as compared to 5% in adults.

  • Therapy for PTLD differs based on the transplanted organ. In liver transplantation, cessation of immunosuppression is recommended as the mainstay of therapy for PTLD. In intestinal transplantation, the extent of the lowering of immunosuppression is limited by the immunogenicity of the transplanted bowel. Antiviral therapies with ganciclovir and intravenous immune globulin (IVIG) are used in both instances. Additional therapies such as rituximab (anti CD20 antibody) and low dose chemotherapy options have significantly contributed to improved outcome after PTLD in intestine transplantation.

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Author information

Authors and Affiliations

  1. Hillman Center for Pediatric Transplantation, Children's Hospital of Pittsburgh (CHP), Thomas E. Starzl Transplantation Institute, University of Pittsburgh School of Medicine, 3705 Fifth Avenue, Suite 7950, Pittsburgh, PA, 15213, USA

    Jaime Pineda

  2. Hillman Center for Pediatric Transplantation, Children's Hospital of Pittsburgh, Pittsburgh, PA, USA

    George V. Mazariegos

Authors
  1. Jaime Pineda
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  2. George V. Mazariegos
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Editor information

Editors and Affiliations

  1. Pediatric Kidney Transplantation, Shands Hospital at UF, University of Florida College of Medicine Medical Director, Gainesville, Florida, USA

    Vikas R. Dharnidharka (Associate Professor and Chief Fellowship Program Director Division of Pediatric Nephrology) (Associate Professor and Chief Fellowship Program Director Division of Pediatric Nephrology)

  2. Division of Infectious Diseases Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA

    Michael Green (Professor of Pediatrics and Surgery) (Professor of Pediatrics and Surgery)

  3. Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA

    Steven A. Webber (Professor of Pediatrics, Chief, Division of Cardiology Co-Director, Heart Center Medical Director, Pediatric Heart and Heart-Lung Transplantation) (Professor of Pediatrics, Chief, Division of Cardiology Co-Director, Heart Center Medical Director, Pediatric Heart and Heart-Lung Transplantation)

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Pineda, J., Mazariegos, G.V. (2010). Posttransplantation Lymphoproliferative Disorder (PTLD) in Liver and Small Bowel Transplant Recipients. In: Dharnidharka, V.R., Green, M., Webber, S.A. (eds) Post-Transplant Lymphoproliferative Disorders. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-01653-0_12

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  • DOI: https://doi.org/10.1007/978-3-642-01653-0_12

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-01652-3

  • Online ISBN: 978-3-642-01653-0

  • eBook Packages: MedicineMedicine (R0)

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