Clinical characteristics and diagnosis and treatment of post-transplantation lymphoproliferative disorder in pediatric kidney transplant recipients

doi:10.3877/cma.j.issn.1674-3903.2025.01.004

Abstract

Abstract:

Objective

To analyze the clinical characteristics and treatment of post-transplantation lymphoproliferative disorder (PTLD) in pediatric renal transplant recipients.

Methods

A retrospective analysis was conducted on the clinical data of children who developed PTLD during the follow-up after kidney transplantation at the Children's Hospital of Fudan University from January 2011 to June 2024,including the onset time, clinical manifestations, treatment plans, and prognosis.

Results

Eight recipients (2.04%) developed PTLD during follow-up, with a median onset interval of 4 months posttransplantation (range 3-14 months). Early-onset PTLD occurred in 7 patients, while 1 presented with late-onset PTLD. The most common initial manifestations were fever (n=7) and gastrointestinal symptoms (n=5). All 7 patients were serologically negative for epstein-barr virus (EBV) before surgery, and all 8 patients were associated with EBV infection when PTLD was diagnosed.Histopathological evaluation identified monomorphic B-cell PTLD in 6 patients and polymorphic PTLD in 1 case (1 patient undiagnosed due to missing biopsy). Initial management with rituximab (RTX)plus chemotherapy in two early-diagnosed patients achieved hematological remission； however, one patient succumbed to a fatal intracranial infection. Subsequent treatment protocol modification incorporating RTX with prophylactic antimicrobial therapy (sulfamethoxazole and posaconazole) in 6 patients resulted in complete PTLD remission with preserved graft function in all patients.

Conclusions

PTLD should be highly vigilant when EBV infection, fever and digestive tract symptoms occur in renal transplant children during follow-up. Monomorphic B-cell and polymorphic PTLD responded well to RTX combined with infection prevention, achieving satisfactory therapeutic outcomes.

Key words: Epstein-barr virus, Post-transplantation lymphoproliferative disorder, Pediatric kidney transplantation, Rituximab

Jinhua Zeng, Xinli Han, Hong Xu, Yihui Zhai, Feng Liu, Rui Chen, Xiaoyan Fang, Zhiqing Zhang, Chunyan Wang, Jing Chen, Qian Shen. Clinical characteristics and diagnosis and treatment of post-transplantation lymphoproliferative disorder in pediatric kidney transplant recipients[J]. Chinese Journal of Transplantation(Electronic Edition), 2025, 19(01): 22-25.

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