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Review
. 2013:2013:814973.
doi: 10.1155/2013/814973. Epub 2013 Sep 24.

Posttransplant lymphoproliferative disease after pediatric solid organ transplantation

Martin Mynarek  1 , Tilmann Schober, Uta Behrends, Britta Maecker-Kolhoff
Affiliations
Review

Posttransplant lymphoproliferative disease after pediatric solid organ transplantation

Martin Mynarek et al. Clin Dev Immunol. 2013.

Abstract

Patients after solid organ transplantation (SOT) carry a substantially increased risk to develop malignant lymphomas. This is in part due to the immunosuppression required to maintain the function of the organ graft. Depending on the transplanted organ, up to 15% of pediatric transplant recipients acquire posttransplant lymphoproliferative disease (PTLD), and eventually 20% of those succumb to the disease. Early diagnosis of PTLD is often hampered by the unspecific symptoms and the difficult differential diagnosis, which includes atypical infections as well as graft rejection. Treatment of PTLD is limited by the high vulnerability towards antineoplastic chemotherapy in transplanted children. However, new treatment strategies and especially the introduction of the monoclonal anti-CD20 antibody rituximab have dramatically improved outcomes of PTLD. This review discusses risk factors for the development of PTLD in children, summarizes current approaches to therapy, and gives an outlook on developing new treatment modalities like targeted therapy with virus-specific T cells. Finally, monitoring strategies are evaluated.

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Figures

Figure 1
Figure 1
Time from transplantation to diagnosis of PTLD of 127 patients in the German Ped-PTLD registry. Kaplan-Meyer curve (continuous line) and 95% confidence intervals (dotted curve). Note the rapid increase within the first year and another in the third year.
Figure 2
Figure 2
Distribution of histological subtypes of pediatric PTLD reported to the German Ped-PTLD registry.
See this image and copyright information in PMC

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