Srpski arhiv za celokupno lekarstvo 2014 Volume 142, Issue 1-2, Pages: 83-88
https://doi.org/10.2298/SARH1402083S
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Post-transplant lymphoproliferative disorder: Case reports of three children with kidney transplant
Spasojević-Dimitrijeva Brankica (Nephrology Department, University Children’s Hospital, Belgrade)
Peco-Antić Amira (Nephrology Department, University Children’s Hospital, Belgrade + Faculty of Medicine, Belgrade)
Paripović Dušan (Nephrology Department, University Children’s Hospital, Belgrade)
Kruščić Divna (Nephrology Department, University Children’s Hospital, Belgrade)
Krstić Zoran (Faculty of Medicine, Belgrade + Urology Department, University Children’s Hospital, Belgrade)
Čupić Maja (Urology Department, University Children’s Hospital, Belgrade)
Cvetković Mirjana (Nephrology Department, University Children’s Hospital, Belgrade)
Miloševski-Lomić Gordana (Nephrology Department, University Children’s Hospital, Belgrade)
Kostić Mirjana (Nephrology Department, University Children’s Hospital, Belgrade + Faculty of Medicine, Belgrade)
Introduction. Post-transplant lymphoproliferative disorder (PTLD) is a
heterogeneous group of diseases, characterized by abnormal lymphoid
proliferation following transplantation. It is a disease of the
immunosuppressed state, and its occurrence is mostly associated with the use
of T-cell depleting agents, and also intensification of immunosuppressive
regimens. In the majority of cases, PTLD is a consequence of Epstein-Barr
virus (EBV) infection and is a B-cell hyperplasia with CD-20 positive
lymphocytes. The 2008 World Health Organization classification for lymphoid
malignancies divides PTLD into four major categories: early lesions,
polymorphic PTLD, monomorphic PTLD and Hodgkin PTLD. The treatment and
prognosis depend on histology. The cornerstone of PTLD therapy includes
reduction/withdrawal of immunosuppression, monoclonal anti CD-20 antibody
(rituximab) and chemotherapy. Outline of Cases. We reported here our
experiences with three patients, two girls aged 7.5 and 15 and a 16-year old
boy. They had different organ involvement: brain, combined spleen-liver and
intestines, respectively. Even though EBV was a trigger of lymphoid
proliferation as it was confirmed by histopathology or in cerebrospinal
fluid, qualitative EBV-PCR was positive only in one patient at disease
presentation. Reduction of immunosuppression therapy was applied in treatment
of all three patients, while two of them received rituximab and ganciclovir.
They had an excellent outcome besides many difficulties in diagnosis and
management of disease. Conclusion. Qualitative EBV-PCR is not useful marker
in pediatric transplant recipients. Our suggestion is that patients with the
risk factors like T-cell depleting agents, immunosuppressant protocol or
increasing immunosuppressive therapy and EBV miss-match with donor must be
more accurately monitored with quantitative EBV PCR.
Keywords: post-transplant lymphoproliferative disorder, Epstein-Barr virus, PCR, pediatric renal transplantation
Projekat Ministarstva
nauke Republike Srbije, br. 175085