Post-transplant Lymphoproliferative Disorder in Pediatric Patients: Clinical Sites of Occurrence and Related Survival Rates.
Bibliographic record
Abstract
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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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".