The IPTA Nashville consensus conference on post-transplant lymphoproliferative disorders after solid organ transplantation in children: IV-consensus guidelines for the management of post-transplant lymphoproliferative disorders in children and adolescents

Upton D Allen¹, Arnaud G L'Huillier², Catherine M Bollard³, Thomas G Gross⁴, Robert J Hayashi⁵, Britta Höcker⁶, Britta Maecker-Kolhoff⁷, Stephen D Marks⁸, George Vincent Mazariegos^{9

10}, Francoise Smets¹¹, Ralf U Trappe^{12

13}, Gary Visner¹⁴, Richard E Chinnock¹⁵, Patrizia Comoli¹⁶, Lara Danziger-Isakov¹⁷, Daniel E Dulek¹⁸, Anne I Dipchand¹⁹, Judith A Ferry²⁰, Olivia M Martinez²¹, Diana M Metes²², Marian G Michaels²³, Jutta Preiksaitis²⁴, James E Squires²⁵, Steven H Swerdlow²⁶, James D Wilkinson²⁷, Vikas R Dharnidharka²⁸, Michael Green²³, Steven A Webber²⁷, Carlos O Esquivel²⁹

Affiliations

¹ Division of Infectious Diseases, Department of Paediatrics, Transplant and Regenerative Medicine Center, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
² Pediatric Infectious Diseases Unit and Laboratory of Virology, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland.
³ Center for Cancer and Immunology Research, Children's National Hospital, The George Washington University, Washington, District of Columbia, USA.
⁴ Center for Cancer and Blood Diseases, Children's Hospital Colorado, Aurora, Colorado, USA.
⁵ Division of Pediatric Hematology/Oncology, St. Louis Children's Hospital, Washington University School of Medicine, St. Louis, Missouri, USA.
⁶ Department of Pediatrics I, Medical Faculty, University Children's Hospital, Heidelberg University, Heidelberg, Germany.
⁷ Hannover Medical School, Pediatric Hematology and Oncology, Hannover, Germany.
⁸ Department of Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, NIHR Great Ormond Street Hospital Biomedical Research Centre, London, UK.
⁹ Hillman Center for Pediatric Transplantation, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA.
¹⁰ Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
¹¹ Pediatric Gastroenterology and Hepatology, Cliniques Universitaires Saint-Luc, UCLouvain, Brussels, Belgium.
¹² Department of Hematology and Oncology, DIAKO Ev. Diakonie-Krankenhaus Bremen, Bremen, Germany.
¹³ Department of Internal Medicine II: Hematology and Oncology, University Medical Centre Schleswig-Holstein, Kiel, Germany.
¹⁴ Division of Pulmonary Medicine, Boston Children's Hospital/Harvard Medical School, Boston, Massachusetts, USA.
¹⁵ Loma Linda University Children's Hospital, Loma Linda, California, USA.
¹⁶ Cell Factory & Pediatric Hematology/Oncology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
¹⁷ Division of Infectious Disease, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio, USA.
¹⁸ Division of Pediatric Infectious Diseases, Monroe Carell Junior Children's Hospital at Vanderbilt and Vanderbilt University Medical Center, Nashville, Tennessee, USA.
¹⁹ Department of Paediatrics, Labatt Family Heart Centre, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
²⁰ Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA.
²¹ Department of Surgery and Program in Immunology, Stanford University School of Medicine, Stanford, California, USA.
²² Thomas E. Starzl Transplantation Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
²³ Division of Pediatric Infectious Diseases, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
²⁴ Division of Infectious Diseases, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
²⁵ Division of Gastroenterology, Hepatology and Nutrition, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
²⁶ Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
²⁷ Department of Pediatrics, Vanderbilt School of Medicine, Nashville, Tennessee, USA.
²⁸ Division of Pediatric Nephrology, Hypertension & Apheresis, Department of Pediatrics, Washington University School of Medicine and St. Louis Children's Hospital, St. Louis, Missouri, USA.
²⁹ Stanford University School of Medicine, Stanford, California, USA.

PMID: 38808744
DOI: 10.1111/petr.14781

Review

The IPTA Nashville consensus conference on post-transplant lymphoproliferative disorders after solid organ transplantation in children: IV-consensus guidelines for the management of post-transplant lymphoproliferative disorders in children and adolescents

Upton D Allen et al. Pediatr Transplant. 2024 Aug.

. 2024 Aug;28(5):e14781.

doi: 10.1111/petr.14781.

Authors

Affiliations

¹ Division of Infectious Diseases, Department of Paediatrics, Transplant and Regenerative Medicine Center, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
² Pediatric Infectious Diseases Unit and Laboratory of Virology, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland.
³ Center for Cancer and Immunology Research, Children's National Hospital, The George Washington University, Washington, District of Columbia, USA.
⁴ Center for Cancer and Blood Diseases, Children's Hospital Colorado, Aurora, Colorado, USA.
⁵ Division of Pediatric Hematology/Oncology, St. Louis Children's Hospital, Washington University School of Medicine, St. Louis, Missouri, USA.
⁶ Department of Pediatrics I, Medical Faculty, University Children's Hospital, Heidelberg University, Heidelberg, Germany.
⁷ Hannover Medical School, Pediatric Hematology and Oncology, Hannover, Germany.
⁸ Department of Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, NIHR Great Ormond Street Hospital Biomedical Research Centre, London, UK.
⁹ Hillman Center for Pediatric Transplantation, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA.
¹⁰ Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
¹¹ Pediatric Gastroenterology and Hepatology, Cliniques Universitaires Saint-Luc, UCLouvain, Brussels, Belgium.
¹² Department of Hematology and Oncology, DIAKO Ev. Diakonie-Krankenhaus Bremen, Bremen, Germany.
¹³ Department of Internal Medicine II: Hematology and Oncology, University Medical Centre Schleswig-Holstein, Kiel, Germany.
¹⁴ Division of Pulmonary Medicine, Boston Children's Hospital/Harvard Medical School, Boston, Massachusetts, USA.
¹⁵ Loma Linda University Children's Hospital, Loma Linda, California, USA.
¹⁶ Cell Factory & Pediatric Hematology/Oncology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
¹⁷ Division of Infectious Disease, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio, USA.
¹⁸ Division of Pediatric Infectious Diseases, Monroe Carell Junior Children's Hospital at Vanderbilt and Vanderbilt University Medical Center, Nashville, Tennessee, USA.
¹⁹ Department of Paediatrics, Labatt Family Heart Centre, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
²⁰ Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA.
²¹ Department of Surgery and Program in Immunology, Stanford University School of Medicine, Stanford, California, USA.
²² Thomas E. Starzl Transplantation Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
²³ Division of Pediatric Infectious Diseases, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
²⁴ Division of Infectious Diseases, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
²⁵ Division of Gastroenterology, Hepatology and Nutrition, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
²⁶ Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
²⁷ Department of Pediatrics, Vanderbilt School of Medicine, Nashville, Tennessee, USA.
²⁸ Division of Pediatric Nephrology, Hypertension & Apheresis, Department of Pediatrics, Washington University School of Medicine and St. Louis Children's Hospital, St. Louis, Missouri, USA.
²⁹ Stanford University School of Medicine, Stanford, California, USA.

PMID: 38808744
DOI: 10.1111/petr.14781

Abstract

The International Pediatric Transplant Association convened an expert consensus conference to assess current evidence and develop recommendations for various aspects of care relating to post-transplant lymphoproliferative disorders (PTLD) after pediatric solid organ transplantation. This report addresses the outcomes of deliberations by the PTLD Management Working Group. A strong recommendation was made for reduction in immunosuppression as the first step in management. Similarly, strong recommendations were made for the use of the anti-CD20 monoclonal antibody (rituximab) as was the case for chemotherapy in selected scenarios. In some scenarios, there is uncoupling of the strength of the recommendations from the available evidence in situations where such evidence is lacking but collective clinical experiences drive decision-making. Of note, there are no large, randomized phase III trials of any treatment for PTLD in the pediatric age group. Current gaps and future research priorities are highlighted.

Keywords: Epstein–Barr virus; PTLD; child; management; solid organ transplantation.

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References

REFERENCES

1. Wilkinson JD, Allen U, Green M, et al. The IPTA Nashville consensus conference on post‐transplant lymphoproliferative disorders after solid organ transplantation in children: I‐methodology for the development of consensus practice guidelines. Pediatr Transplant. 2022:28(1)e14333. doi:10.1111/petr.14333
1. Guyatt GH, Oxman AD, Vist GE, et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ. 2008;336(7650):924‐926.
1. Andrews J, Guyatt G, Oxman AD, et al. GRADE guidelines: 14. Going from evidence to recommendations: the significance and presentation of recommendations. J Clin Epidemiol. 2013;66(7):719‐725.
1. Schunemann HJ, Jaeschke R, Cook DJ, et al. An official ATS statement: grading the quality of evidence and strength of recommendations in ATS guidelines and recommendations. Am J Respir Crit Care Med. 2006;174(5):605‐614.
1. Guyatt G, Oxman AD, Akl EA, et al. GRADE guidelines: 1. Introduction‐GRADE evidence profiles and summary of findings tables. J Clin Epidemiol. 2011;64(4):383‐394.

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The IPTA Nashville consensus conference on post-transplant lymphoproliferative disorders after solid organ transplantation in children: IV-consensus guidelines for the management of post-transplant lymphoproliferative disorders in children and adolescents

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The IPTA Nashville consensus conference on post-transplant lymphoproliferative disorders after solid organ transplantation in children: IV-consensus guidelines for the management of post-transplant lymphoproliferative disorders in children and adolescents

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