Post-transplant Lymphoproliferative Disorder in Pediatric Patients: Clinical Sites of Occurrence and Related Survival Rates.
Notice bibliographique
Résumé
Background. Post-transplant lymphoproliferative disorder (PTLD) is a devastating complication of organ transplantation. The majority of cases are associated with the Epstein-Barr virus (EBV). The factors influencing mortality are variable. The aim of the study was to review trends in PTLD rates, the sites of involvement on presentation and the associated survival rates. Methods. In a hospital-based PTLD registry, we identified biopsy-proven cases of PTLD among children < 18 years of age over a 15-years period (2000–2014). Cases that were included had at least 1 year of follow-up after the initial diagnosis of PTLD. Recurrent cases of PTLD were excluded. Results. Eighty-two patients with a first episode of PTLD were included. Median age at diagnosis was 6.4 years (interquartile range (IQR) 3.2–12.3). Median time post-transplantation at diagnosis of PTLD was 1.44 years (IQR 0.5–4.2). With respect to number of PTLD cases occurring as a proportion of patients transplanted, the frequency of PTLD was highest in multi-organ transplant recipients (32%), followed by lung (20%) and heart recipients (14%). PTLD was less common among liver (9%) and kidney transplant recipients (5%). The most frequent PTLD sites were tonsillar/adenoidal (T/A, 34%), gastrointestinal (GI) tract (32%), lymph node (11%) and multisite (11%). Mortality at 1 year was lower in cases of T/A PTLD (1/28, 3.6%) compared with PTLD at other sites (13/54, 24.1%; P = .028). At 5 years, the difference remained significant (2/17, 11.8% vs 22/46, 47.8%; P = .01). When compared with T/A PTLD, lymph node PTLD was associated with a higher mortality at 1 year (4/9, 44.4%; P = .008) and 5 years (5/9, 55.5%; P = .028). Similarly, multisite PTLD was associated with increased mortality at 5 years (5/9, 55.5%; P = .028) compared with T/A PTLD. With respect to the transplanted organ, lung transplant patients had a higher all-cause mortality (4/9, 44.4%) than other transplant patients (10/73, 13.7%; P = .042) at 1 year after the diagnosis of PTLD. This remained significant at 5 years (7/9, 77.8% vs 17/54, 31.5%; P = .021). Conclusion. Among first episodes of PTLD, T/A and GI sites accounted for the majority of cases. T/A PTLD was associated with a survival advantage when compared with PTLD located at other sites. There are potential clinical, virologic or other reasons for these findings, which require further study. Disclosures. All authors: No reported disclosures.
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».