Identifying predictive factors for posttransplant lymphoproliferative disease in pediatric solid organ transplant recipients with Epstein-Barr virus viremia. | LitMetric
*Division of Pediatric Hematology/Oncology, Children's Hospital at Montefiore, Bronx †Division of Pediatric Hematology/Oncology, Morgan Stanley Children's Hospital, New York Divisions of ¶Pediatric Nephrology #Pathology **Pediatric Hematology/Oncology, Mount Sinai Medical Center, New York, NY ‡Division of Pediatric Gastroenterology/Hepatology, Phoenix Children's Hospital, Phoenix, AZ §Division of Pediatric Gastroenterology, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL ∥Division of Pediatric Critical Care, North Carolina Children's Hospital, Chapel Hill, NC.
Published: November 2014
AI Article Synopsis
Article Abstract
Epstein-Barr virus (EBV) viremia (EV) in pediatric solid organ transplant (SOT) recipients is a significant risk factor for posttransplant lymphoproliferative disease (PTLD) but not all patients with EV develop PTLD. We identify predictive factors for PTLD in patients with EV. We conducted a retrospective chart review of all pediatric SOT recipients (0 to 21 y) at a single institution between 2001 and 2009. A total of 350 pediatric patients received a SOT and 90 (25.7%) developed EV. Of EV patients, 28 (31%) developed PTLD. The median age at transplant was 11.5 months in the PTLD group and 21.5 months in the EV-only group (P=0.003). Twenty-three (37%) EV-only patients had immunosuppression increased before EV, compared with 28 (100%) of PTLD patients (P<0.001). The median peak EBV level was 3212 EBV copies/10 lymphocytes for EV-only and 8392.5 EBV copies/10 lymphocytes for PTLD (P=0.005). All patients who developed PTLD had ≥1 clinical symptoms. Younger age at transplant, increased immunosuppression before EV, higher peak EBV level, and presence of clinical symptoms have predictive value in the development of PTLD in SOT patients with EV.
It is now well understood that the effect of TB does not always end when a patient completes a successful course of treatment. Successful treatment is by definition a microbiological cure, but people may continue to suffer the consequences of TB for months or years after treatment. For example, ongoing health challenges can present in the form of post-TB lung disease (PTLD), and there is a high incidence of TB-related symptoms associated with disability in other domains.
Central nervous system (CNS) involvement by lymphoproliferative disorders is rare and associated with a poor prognosis. CNS involvement can be exclusive, primary or appear in a secondary manner as part of a systemic process. The spectrum of involvement that we encounter is varied and neuroimaging plays a key role in diagnosis.
Post-transplant lymphoproliferative disorders (PTLD) are a heterogeneous category of disease entities occurring in the context of iatrogenic immune suppression. Epstein-Barr virus (EBV)-driven B-cell lymphoproliferation represents the prototype of quintessential PTLD, which includes a range of histologies named nondestructive, polymorphic, and monomorphic EBV+ diffuse large B-cell lymphoma (DLBCL) PTLD. While EBV is associated with the majority of PTLD cases, other drivers of lymphoid neoplasia and lymphoma transformation can occur-with or without EBV as a codriver-thus underlining its vast heterogeneity.
Post-transplant lymphoproliferative disease (PTLD) is a rare but life-threatening disease that occurs after organ transplantation. Histopathology is the gold standard for the diagnosis of PTLD. Because of its rarity and atypical symptoms, many patients are misdiagnosed with liver abscess, liver cancer, or missed diagnosis long before pathological diagnosis is obtained, thus delaying treatment.
Background/objective: To determine if anti-RA33 antibodies, which can be seen in early forms of inflammatory arthritis, are present in patients with Lyme arthritis (LA).
Methods: Anti-RA33 antibodies were tested using a commercially available assay in patients with LA (n = 47) and compared with patients with erythema migrans who returned to health (EM RTH, n = 20) and those with post-treatment Lyme disease (PTLD) (n = 50), characterized by noninflammatory arthralgia, as an observational comparative study utilizing Lyme-exposed patients from various original cohorts.
Results: We found that anti-RA33 was present in higher proportions of patients with LA (23.
