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Zaffiri L, Chambers ET. Screening and Management of PTLD. Transplantation 2023; 107:2316-2328. [PMID: 36949032 DOI: 10.1097/tp.0000000000004577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2023]
Abstract
Posttransplant lymphoproliferative disorder (PTLD) represents a heterogeneous group of lymphoproliferative diseases occurring in the setting of immunosuppression following hematopoietic stem cells transplant and solid organ transplantation. Despite its overall low incidence, PTLD is a serious complication following transplantation, with a mortality rate as high as 50% in transplant recipients. Therefore, it is important to establish for each transplant recipient a personalized risk evaluation for the development of PTLD based on the determination of Epstein-Barr virus serostatus and viral load following the initiation of immunosuppression. Due to the dynamic progression of PTLD, reflected in the diverse pathological features, different therapeutic approaches have been used to treat this disorder. Moreover, new therapeutic strategies based on the administration of virus-specific cytotoxic T cells have been developed. In this review, we summarize the available data on screening and treatment to suggest a strategy to identify transplant recipients at a higher risk for PTLD development and to review the current therapeutic options for PTLD.
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Affiliation(s)
- Lorenzo Zaffiri
- Division of Pulmonary and Critical Care Medicine, Cedars-Sinai Medical Center, Los Angeles, CA
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Betancur V, Zughul R, Ivanovic A, Madrazo BL, Castillo P, Casillas J, Alessandrino F. Ultrasound of pancreatic transplant complications: a primer for radiologists. Clin Radiol 2023; 78:861-871. [PMID: 37679209 DOI: 10.1016/j.crad.2023.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 08/10/2023] [Accepted: 08/13/2023] [Indexed: 09/09/2023]
Abstract
Pancreatic transplantation is an established treatment for patients with type 1 diabetes patients and select type 2 diabetes patients, with excellent survival rates as graft health is evaluated through regular imaging and early detection of complications. Amongst the various imaging methods that may aid in diagnosis of pancreatic transplant complications, ultrasound is a widely available, quick, portable, and cost-effective technique, often used as the sole method to assess for pancreatic transplant complications. When assessing a patient with a pancreatic transplant, the radiologist should be methodical in assessing the vasculature, the pancreatic parenchyma, and the peripancreatic regions. Complications can be categorised based on time from transplant and type of complications, and include vascular, parenchymal, and enteric/anastomotic complications. Doppler has a major role in the diagnosis of vascular complications including arterial and venous thrombosis, arterial stenosis, pseudoaneurysms, and haematomas. Pancreatic complications include rejections and pancreatitis, and are often diagnosed through a combination of clinical, laboratory, and imaging findings, such as pancreatic heterogeneity or the presence of pancreatic pseudocysts. Enteric/anastomotic complications include leaks and bowel obstructions, and may require cross-sectional imaging in addition to ultrasound. This review covers the most common and high-impact vascular, parenchymal, and enteric/anastomotic complications that should be considered in every radiologist's search pattern when assessing a pancreatic graft, as well as their respective postoperative timeframes.
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Affiliation(s)
- V Betancur
- Leonard M. Miller School of Medicine, University of Miami, FL, USA
| | - R Zughul
- Department of Radiology, Jackson Memorial Hospital, Miami, FL, USA
| | - A Ivanovic
- Department of Diagnostic Imaging, Faculty of Medicine, Center for Radiology and MRI, Clinical Center of Serbia, Belgrade, Serbia
| | - B L Madrazo
- Division of Abdominal Imaging, Department of Radiology, Leonard M. Miller School of Medicine, Miami, FL, USA
| | - P Castillo
- Division of Abdominal Imaging, Department of Radiology, Leonard M. Miller School of Medicine, Miami, FL, USA
| | - J Casillas
- Division of Abdominal Imaging, Department of Radiology, Leonard M. Miller School of Medicine, Miami, FL, USA
| | - F Alessandrino
- Division of Abdominal Imaging, Department of Radiology, Leonard M. Miller School of Medicine, Miami, FL, USA.
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Keshtkar A, Karbasian F, Reihani H, Atighi F, Hedayati SB, Ataollahi M, Geramizadeh B, Dehghani SM. A pediatric case series of catastrophic gastrointestinal complications of posttransplant lymphoproliferative disease with increasing incidence, high association with coronavirus disease 2019, higher mortality, and a plea for early endoscopy to prevent late fatal outcome. J Med Case Rep 2023; 17:396. [PMID: 37723518 PMCID: PMC10507962 DOI: 10.1186/s13256-023-04123-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 08/11/2023] [Indexed: 09/20/2023] Open
Abstract
BACKGROUND Posttransplant lymphoproliferative disorder is one of the most severe complications after transplantation, caused by uncontrolled proliferation of Epstein-Barr virus-positive B-cells in the setting of chronic immunosuppression. As one of the biggest transplant centers worldwide, we observed a potential increase in the number of patients with posttransplant lymphoproliferative disorder presenting with gastrointestinal symptoms in 1 year, during the coronavirus disease 2019 pandemic. There is limited information about dysregulation of the immune system following coronavirus disease 2019 infection, which may lead to Epstein-Barr virus reactivation in Epstein-Barr virus-positive B-cells and development of posttransplant lymphoproliferative disorder. Furthermore, there is no consensus in literature on a modality that can help in early diagnosis of posttransplant lymphoproliferative disorder with nonspecific gastrointestinal presentations before late and fatal complications occur. CASE PRESENTATION Our case series includes five Iranian (Persian) patients, three female (2, 2.5, and 5 years old) and two male (2 and 2.5 years old), who developed gastrointestinal posttransplant lymphoproliferative disorder after liver transplantation. All of our patients were on a similar immunosuppressant regimen and had similar Epstein-Barr virus serologic status (seronegative at time of transplantation but seropositive at time of posttransplant lymphoproliferative disorder diagnosis). Four patients had either a positive coronavirus disease 2019 polymerase chain reaction test or exposure within the family. Although all of our patients presented with nonspecific gastrointestinal symptoms, four patients developed late posttransplant lymphoproliferative disorder complications such as bowel perforation and obstruction. All five patients with gastrointestinal posttransplant lymphoproliferative disorder received chemotherapy, but only two survived and currently are continuing the therapy. In one of the surviving patients, prompt endoscopic investigation resulted in early diagnosis of posttransplant lymphoproliferative disorder and a better outcome. CONCLUSION Since 80% of our patients had exposure to coronavirus, a potential relationship might be suggested between the two. Furthermore, as we witnessed in one case, urgent endoscopic investigation in immunocompromised patients presenting with gastrointestinal symptoms can improve the clinical outcomes and therefore should be considered for early diagnosis of posttransplant lymphoproliferative disorder.
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Affiliation(s)
- Alireza Keshtkar
- Student Research Committee, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fereshteh Karbasian
- Pediatric Gastroenterology, Hepatology and Nutrition, Ali-Asghar Children's Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Hamid Reihani
- Student Research Committee, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Farnaz Atighi
- Student Research Committee, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Maryam Ataollahi
- Department of Pediatric Gastroenterology, Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Bita Geramizadeh
- Shiraz Transplant Research Center (STRC), Shiraz University of Medical Sciences, Shiraz, Iran
- Department of Pathology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Seyed Mohsen Dehghani
- Department of Pediatric Gastroenterology, Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Ji H, Yang T, Li C, Zhu Y, Zheng Z, Zhang J, Liu Y, Gao Y, Wu H, Jiang J, Yong J, Chen M, Tang Y, Xia Q, Xue F. EBV-encoded miRNAs BHRF1-1 and BART2-5p aggravate post- transplant lymphoproliferative disorder via LZTS2-PI3K-AKT axis. Biochem Pharmacol 2023:115676. [PMID: 37419372 DOI: 10.1016/j.bcp.2023.115676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 06/28/2023] [Accepted: 06/28/2023] [Indexed: 07/09/2023]
Abstract
Post-transplant lymphoproliferative disorder (PTLD) is one of the most serious complications after transplantation. Epstein-Barr virus (EBV) is a key pathogenic driver of PTLD. About 80% of PTLD patients are EBV positive. However, the accuracy of preventing and diagnosing EBV-PTLD by monitoring EBV DNA load is limited. Therefore, new diagnostic molecular markers are urgently needed. EBV-encoded miRNAs can regulate a variety of EBV-associated tumors and are expected to be potential diagnostic markers and therapeutic targets. We found BHRF1-1 and BART2-5p were significantly elevated in EBV-PTLD patients, functionally promoting proliferation and inhibiting apoptosis in EBV-PTLD. Mechanistically, we first found that LZTS2 acts as a tumor suppressor gene in EBV-PTLD, and BHRF1-1 and BART2-5p can simultaneously inhibit LZTS2 and activate PI3K-AKT pathway. This study shows that BHRF1-1 and BART2-5p can simultaneously inhibit the expression of tumor suppressor LZTS2, and activate the PI3K-AKT pathway, leading to the occurrence and development of EBV-PTLD. Therefore, BHRF1-1 and BART2-5p are expected to be potential diagnostic markers and therapeutic targets for EBV-PTLD patients.
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Affiliation(s)
- Hao Ji
- Department of Liver Surgery and Liver Transplantation Center, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Taihua Yang
- Department of Liver Surgery and Liver Transplantation Center, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chunlai Li
- Department of Liver Surgery and Liver Transplantation Center, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Engineering Research Center of Transplantation and Immunology, Shanghai, China
| | - Youwei Zhu
- Shanghai Institute of Rheumatology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhigang Zheng
- Department of Liver Surgery and Liver Transplantation Center, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiaxu Zhang
- Department of Liver Surgery and Liver Transplantation Center, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuan Liu
- Department of Liver Surgery and Liver Transplantation Center, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yijin Gao
- Department of Hematology & Oncology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, National Health Committee Key Laboratory of Pediatric Hematology & Oncology, Shanghai, China
| | - Huimin Wu
- Department of Liver Surgery and Liver Transplantation Center, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jinxing Jiang
- Department of Hematology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Junekong Yong
- Department of Liver Surgery and Liver Transplantation Center, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Mengke Chen
- Shanghai Institute of Rheumatology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuanjia Tang
- Shanghai Institute of Rheumatology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; State Key Laboratory of Oncogenes and Related Genes, Shanghai Cancer Institute, Renji Hospital, 2200 Lane 25 Xietu Road, Shanghai, China.
| | - Qiang Xia
- Department of Liver Surgery and Liver Transplantation Center, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Engineering Research Center of Transplantation and Immunology, Shanghai, China; Shanghai Institute of Transplantation, Shanghai, China
| | - Feng Xue
- Department of Liver Surgery and Liver Transplantation Center, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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Franco A, Hernandez D, Zarraga S, Fructuoso AS, Crespo M, Mazuecos A, Corte CD, Benot AR, Ruiz JC, Beneyto I. Lymphoproliferative disorders after renal transplantation along 2 decades: a large longitudinal study of 21.546 recipients. Nefrologia 2023; 43:427-434. [PMID: 37813738 DOI: 10.1016/j.nefroe.2023.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 02/17/2022] [Accepted: 02/20/2022] [Indexed: 10/11/2023] Open
Abstract
INTRODUCTION Post transplant lymphoproliferative disorders (PTLD) are heterogeneous lymphoid proliferations in recipients of solid organs which seem to be related to Epstein Barr Virus (EBV). The use of antilymphocyte antibodies, EBV seronegativity in the recipient,acute rejection and CMV infection have been identified as classical risk factors. MATERIAL Y METHODS We have studied in a retrospective observational study, the incidence of PTLD in a period of 22 years, its relationship with EBV, presence of classical risk factors and outcome in 21546 simple adult renal transplant recipients from cadaveric and living donors, transplanted in 21 hospitals from 1990 to 2009. RESULTS A total of 275 recipients developed PTLD (1,2%),195 males (70,9%), 80 females (29,1%) aged 59.2 (p25 44.7 p75 68)years. Two hundred forty-five (89.0%) were 1st transplant recipients and 269 (97,8%) from cadaveric donors. EBV in the tissue was reported in 94 out of the 155 studied recipients (60.6%) and 86.0% of the proliferations were due to B lymphocytes. PTLD median appearance after transplant were 42.months (p25, 75, 12, 77, 5). One hundred eighty-eight recipients out of 275 patients (68.3%) had any classical risk factor and the use of antilymphocyte antibodies was the most frequent. During the follow-up, 172 patients died (62,5%) and 103 (37,5%) had a complete remission. The main cause of death was PTLD progression (n = 91, 52,9%), followed by sepsis (n = 24, 13,9%). The follow-up period post-transplant of the recipients was between 3 and 22 years. The incidence was 0,14% during the first year post-trasplant and 0.98% the cumulative incidence at 10 years. Patient survival after diagnosis was 51%, 44% and 39% after 1, 2 and 5 years, respectively. Finally, overall graft survival was 48%, 39% and 33% at the same periods. CONCLUSION PTLD has a low incidence in renal transplant recipients. Most of the proliferations are due to B lymphocytes and seem to have a close relationship with EBV. PTLD can develop in the absence of classical risk factors. The prognosis is poor, mainly due to PTLD progression, but the survivors can even maintain their grafts.
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Affiliation(s)
- Antonio Franco
- Servicio de Nefrología, Hospital General de Alicante, Alicante, Spain.
| | | | - Sofia Zarraga
- Servicio de Nefrologia, Hospital de Cruces, Baracaldo, Vizcaya, Spain
| | | | - Marta Crespo
- Servicio de Nefrologia, Hospital del Mar, Barcelona, Spain
| | | | | | | | - Juan Carlos Ruiz
- Servicio de Nefrologia, Hospital Marque de Valdecilla, Santander, Cantabria, Spain
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Incidence of Lymphoproliferative Disorders After Renal Transplantation is Down, but the Poor Prognosis Remains. Multicenter 32-Year Cohort Study. Transplant Proc 2022; 54:2462-2466. [DOI: 10.1016/j.transproceed.2022.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 10/01/2022] [Indexed: 11/15/2022]
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Lupo J, Wielandts AS, Buisson M, Consortium CRYOSTEM, Habib M, Hamoudi M, Morand P, Verduyn-Lunel F, Caillard S, Drouet E. High Predictive Value of the Soluble ZEBRA Antigen (Epstein-Barr Virus Trans-Activator Zta) in Transplant Patients with PTLD. Pathogens 2022; 11:pathogens11080928. [PMID: 36015048 PMCID: PMC9413454 DOI: 10.3390/pathogens11080928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 07/28/2022] [Accepted: 08/03/2022] [Indexed: 11/16/2022] Open
Abstract
The ZEBRA (Z EBV replication activator) protein is the major transcription factor of EBV, expressed upon EBV lytic cycle activation. An increasing body of studies have highlighted the critical role of EBV lytic infection as a risk factor for lymphoproliferative disorders, such as post-transplant lymphoproliferative disease (PTLD). We studied 108 transplanted patients (17 PTLD and 91 controls), retrospectively selected from different hospitals in France and in the Netherlands. The majority of PTLD were EBV-positive diffuse large B-cell lymphomas, five patients experienced atypical PTLD forms (EBV-negative lymphomas, Hodgkin’s lymphomas, and T-cell lymphomas). Fourteen patients among the seventeen who developed a pathologically confirmed PTLD were sZEBRA positive (soluble ZEBRA, plasma level above 20 ng/mL, measured by an ELISA test). The specificity and positive predictive value (PPV) of the sZEBRA detection in plasma were 98% and 85%, respectively. Considering a positivity threshold of 20 ng/mL, the sensitivity of the sZEBRA was 82.35% and the specificity was 94.51%. The mean of the sZEBRA values in the PTLD cases were significantly higher than in the controls (p < 0.0001). The relevance of the lytic cycle and, particularly, the role of ZEBRA in lymphomagenesis is a new paradigm pertaining to the prevention and treatment strategies for PTLD. Given the high-specificity and the predictive values of this test, it now appears relevant to investigate the lytic EBV infection in transplanted patients as a prognostic biomarker.
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Affiliation(s)
- Julien Lupo
- Institut de Biologie Structurale, Université Grenoble-Alpes, 38000 Grenoble, France
- Laboratoire de Virologie, Institut de Biologie-Pathologie, Centre Hospitalier Universitaire Grenoble Alpes, 38000 Grenoble, France
| | - Anne-Sophie Wielandts
- Laboratoire de Virologie, Institut de Biologie-Pathologie, Centre Hospitalier Universitaire Grenoble Alpes, 38000 Grenoble, France
| | - Marlyse Buisson
- Institut de Biologie Structurale, Université Grenoble-Alpes, 38000 Grenoble, France
- Laboratoire de Virologie, Institut de Biologie-Pathologie, Centre Hospitalier Universitaire Grenoble Alpes, 38000 Grenoble, France
| | - CRYOSTEM Consortium
- CRYOSTEM Consortium: Marseille Innovation—Hôtel Technologique, 13382 Marseille, France
| | - Mohammed Habib
- Laboratoire de Virologie, Institut de Biologie-Pathologie, Centre Hospitalier Universitaire Grenoble Alpes, 38000 Grenoble, France
| | - Marwan Hamoudi
- Institut de Biologie Structurale, Université Grenoble-Alpes, 38000 Grenoble, France
| | - Patrice Morand
- Institut de Biologie Structurale, Université Grenoble-Alpes, 38000 Grenoble, France
- Laboratoire de Virologie, Institut de Biologie-Pathologie, Centre Hospitalier Universitaire Grenoble Alpes, 38000 Grenoble, France
| | | | - Sophie Caillard
- Département de Néphrologie et de Transplantation Centre, Hospitalier Universitaire de Strasbourg, 67091 Strasbourg, France
| | - Emmanuel Drouet
- Institut de Biologie Structurale, Université Grenoble-Alpes, 38000 Grenoble, France
- Correspondence:
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CANDAR Ö, ZOR TURNA T. Post-transplant Lymphoproliferative Disorder Following Kidney Transplantation,. TURKISH JOURNAL OF INTERNAL MEDICINE 2022. [DOI: 10.46310/tjim.1073449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Enfermedad linfoproliferativa difusa postrasplante renal: estudio longitudinal de 21.546 receptores durante 2 décadas en España. Nefrologia 2022. [DOI: 10.1016/j.nefro.2022.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Füreder A, Kropshofer G, Benesch M, Dworzak M, Greil S, Huber W, Hubmann H, Lawitschka A, Mann G, Michel‐Behnke I, Müller‐Sacherer T, Pichler H, Simonitsch‐Klupp I, Schwinger W, Szepfalusi Z, Crazzolara R, Attarbaschi A. Characteristics, management, and outcome of pediatric patients with post-transplant lymphoproliferative disease-A 20 years' experience from Austria. Cancer Rep (Hoboken) 2021; 4:e1375. [PMID: 33755341 PMCID: PMC8551996 DOI: 10.1002/cnr2.1375] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 03/02/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Management of pediatric post-transplantation lymphoproliferative disorder (PTLD) after hematopoietic stem cell (HSCT) and solid organ transplantation (SOT) is challenging. AIM This study of 34 PTLD patients up to 19-years old diagnosed in Austria from 2000 to 2018 aimed at assessing initial characteristics, therapy, response, and outcome as well as prognostic markers of this rare pediatric disease. METHODS AND RESULTS A retrospective data analysis was performed. Types of allografts were kidney (n = 12), liver (n = 7), heart (n = 5), hematopoietic stem cells (n = 4), lungs (n = 2), multi-visceral (n = 2), small intestine (n = 1), and vessels (n = 1). Eighteen/34 were classified as monomorphic PTLD, with DLBCL accounting for 15 cases. Polymorphic disease occurred in nine, and non-destructive lesions in six cases. One patient had a non-classifiable PTLD. Thirteen/34 patients are surviving event-free in first remission (non-destructive, n = 4/6; polymorphic, n = 4/9; monomorphic, n = 6/18). Fourteen/34 patients lacked complete response to first-line therapy, of whom seven died. Four/34 patients relapsed, of whom two died. In 3/34 patients, death occurred as a first event. The 5-year overall and event-free survival rates were 64% ± 9% and 35% ± 9% for the whole cohort. Among all parameters analyzed, only malignant disease as the indication for transplantation had a significantly poor influence on survival. CONCLUSIONS This study shows PTLD still to be a major cause of mortality following SOT or HSCT in children. A continued understanding of the molecular biology of the disease shall allow to decrease treatment intensity for lower risk patients and to identify patients who may benefit from newer therapy approaches to improve outcome and decrease morbidity.
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Affiliation(s)
- Anna Füreder
- Department of Pediatric Hematology and OncologySt. Anna Children's HospitalViennaAustria
- Department of Pediatrics and Adolescent MedicineMedical University of ViennaViennaAustria
| | - Gabriele Kropshofer
- Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent MedicineMedical University of InnsbruckInnsbruckAustria
| | - Martin Benesch
- Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent MedicineMedical University of GrazGrazAustria
| | - Michael Dworzak
- Department of Pediatric Hematology and OncologySt. Anna Children's HospitalViennaAustria
- Department of Pediatrics and Adolescent MedicineMedical University of ViennaViennaAustria
| | - Sabine Greil
- Division of Pediatric Cardiology, Department of Pediatrics and Adolescent Medicine, Pediatric Heart CenterMedical University of ViennaViennaAustria
| | - Wolf‐Dietrich Huber
- Department of Pediatrics and Adolescent MedicineMedical University of ViennaViennaAustria
| | - Holger Hubmann
- Division of General Pediatrics, Department of Pediatrics and Adolescent MedicineMedical University of GrazGrazAustria
| | - Anita Lawitschka
- Department of Pediatric Hematology and OncologySt. Anna Children's HospitalViennaAustria
- Department of Pediatrics and Adolescent MedicineMedical University of ViennaViennaAustria
| | - Georg Mann
- Department of Pediatric Hematology and OncologySt. Anna Children's HospitalViennaAustria
| | - Ina Michel‐Behnke
- Division of Pediatric Cardiology, Department of Pediatrics and Adolescent Medicine, Pediatric Heart CenterMedical University of ViennaViennaAustria
| | - Thomas Müller‐Sacherer
- Department of Pediatrics and Adolescent MedicineMedical University of ViennaViennaAustria
| | - Herbert Pichler
- Department of Pediatric Hematology and OncologySt. Anna Children's HospitalViennaAustria
- Department of Pediatrics and Adolescent MedicineMedical University of ViennaViennaAustria
| | | | - Wolfgang Schwinger
- Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent MedicineMedical University of GrazGrazAustria
| | - Zsolt Szepfalusi
- Division of Pediatric Pulmonology, Allergy and Endocrinology, Department of Pediatrics and Adolescent Medicine, Comprehensive Center PediatricsMedical University of ViennaViennaAustria
| | - Roman Crazzolara
- Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent MedicineMedical University of InnsbruckInnsbruckAustria
| | - Andishe Attarbaschi
- Department of Pediatric Hematology and OncologySt. Anna Children's HospitalViennaAustria
- Department of Pediatrics and Adolescent MedicineMedical University of ViennaViennaAustria
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Shizuku M, Kamei H, Yoshizawa A, Ito Y, Ogura Y, Yoshikawa J, Kurata N, Jobara K, Kodera Y. The impact of chronic Epstein-Barr virus infection on the liver graft of pediatric liver transplant recipients: A retrospective observational study. Transpl Infect Dis 2021; 23:e13731. [PMID: 34500501 DOI: 10.1111/tid.13731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 08/23/2021] [Accepted: 09/01/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Chronic high Epstein-Barr virus loads (CHEBV) are commonly observed in pediatric liver transplant patients. However, it is unclear how CHEBV impacts the liver graft. The aim of this study was to clarify the clinical and pathological impacts of CHEBV on the liver graft. METHODS From 2012 to 2020, we retrospectively investigated 46 pediatric liver transplant patients (under 16 years) who survived ≥6 months. The patients were divided into two groups: CHEBV group (EBV DNA >10 000 IU/ml of whole blood for ≥6 months) and nonchronic high EBV (NCHEBV) group (patients who did not meet CHEBV criteria). Tacrolimus was reduced to <3.0 ng/ml in patients with EBV DNA >5000 IU/ml. Blood biochemistry data and pathological findings, obtained at the time of protocol and episodic biopsies, were compared between the two groups. RESULTS Out of 46 patients, 28 CHEBV and 18 NCHEBV patients were enrolled. The blood biochemical examination did not show a significant difference between the two groups. In addition, no significant differences between the two groups were found in the pathological findings, including frequency of late acute rejection and the progression of fibrosis at the time of both protocol and episodic biopsies. Appropriate adjustment of immunosuppression for CHEBV management may have contributed to the prevention of the progression of fibrosis. CONCLUSION CHEBV had little adverse effect on the liver graft. Graft fibrosis might have been avoided through optimal dose modification of tacrolimus. Further long-term monitoring is necessary because CHEBV may affect the pediatric liver graft in the long term.
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Affiliation(s)
- Masato Shizuku
- Department of Transplantation Surgery, Nagoya University Hospital, Nagoya, Japan.,Department of Transplantation and Endocrine Surgery (Surgery II), Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hideya Kamei
- Department of Transplantation Surgery, Nagoya University Hospital, Nagoya, Japan
| | - Atsushi Yoshizawa
- Department of Transplantation Surgery, Nagoya University Hospital, Nagoya, Japan.,Department of Gastroenterology Surgery, Kansai Electric Power Hospital, Osaka, Japan
| | - Yoshinori Ito
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yasuhiro Ogura
- Department of Transplantation Surgery, Nagoya University Hospital, Nagoya, Japan
| | - Junichi Yoshikawa
- Department of Transplantation Surgery, Nagoya University Hospital, Nagoya, Japan
| | - Nobuhiko Kurata
- Department of Transplantation Surgery, Nagoya University Hospital, Nagoya, Japan
| | - Kanta Jobara
- Department of Transplantation Surgery, Nagoya University Hospital, Nagoya, Japan
| | - Yasuhiro Kodera
- Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, Nagoya, Japan
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Abstract
In liver transplant patients, solid tumors and post-transplant lymphoproliferative disorders (PTLD) have emerged as significant long-term mortality causes. Additionally, it is assumed that de novo malignancy (DNM) after liver transplantation (LT) is the second-leading cause of death after cardiovascular complications. Well-established risk factors for PTLD and solid tumors are calcineurin inhibitors (CNIs), tacrolimus (TAC), and cyclosporine, the cornerstones of all immunosuppressive (IS) therapies used after LT. The loss of immunocompetence facilitated by the host immune system due to prolonged IS therapy leads to cancer development, including in LT patients. Hindering DNA repair mechanisms, promoting tumor cell invasiveness, and hampering apoptosis are critical events in tumorigenesis and tumor growth in LT patients resulting from IS administration. This paper aims to overview the refined mechanisms of IS-induced tumorigenesis after LT and the loss of immunocompetence facilitated by the host immune system due to prolonged IS therapy. In addition, we also discuss in detail the mechanisms of action in different types of IS regimen used after LT, and their putative effect on DNM.
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13
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Yen LH, Sabatino JC. Imaging complications of liver transplantation: a multimodality pictorial review. Abdom Radiol (NY) 2021; 46:2444-2457. [PMID: 31679057 DOI: 10.1007/s00261-019-02270-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Liver transplantation is one of the most commonly performed surgical procedures for the treatment of end-stage liver disease and hepatocellular carcinoma. Post-transplantation complications include vascular, nonvascular, and biliary. Common imaging techniques used to evaluate the hepatic graft are ultrasonography (US), CT, MR imaging, cholangiography, angiography, and scintigraphy. The purposes of this pictorial review are to review imaging findings of complications of liver transplantation and provide a framework for early detection of post-surgical complications.
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An Unusual Cause of Acute Pancreatitis in a Liver Transplant Recipient. Transplant Direct 2021; 7:e694. [PMID: 33937519 PMCID: PMC8081465 DOI: 10.1097/txd.0000000000001129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 01/05/2021] [Accepted: 01/08/2021] [Indexed: 11/26/2022] Open
Abstract
Posttransplant lymphoproliferative disorder (PTLD) in liver transplant recipients is relatively uncommon, with an estimated incidence of 1%–3%. Retrospective reviews of liver transplant recipients have mainly reported posttransplant lymphoproliferative disorder affecting the liver, gastrointestinal tract, or lymph nodes. In this case report, we describe a 45-y-old female with a history of deceased donor liver transplantation for autoimmune hepatitis who had recurrent hospital admissions for acute pancreatitis. Ultimately, imaging revealed numerous complex pancreatic and peripancreatic masses, appearing to originate from pancreatic lymphoid tissue. Tissue biopsy later confirmed monomorphic Epstein-Barr virus-negative large B-cell lymphoma. Overall, PTLD involving the pancreas after liver transplantation is incredibly rare. The patient’s cumulative immunosuppression drug dose and time posttransplant were suspected to be her main risk factors, given that she had been exposed to several years of treatment with tacrolimus, azathioprine, mycophenolate mofetil, and prednisone. She was treated with rituximab monotherapy and later escalated to chemoimmunotherapy due to lack of response. PTLD involving the pancreas is an unusual cause of pancreatitis and should be considered in cases of recurrent pancreatitis in transplant recipients.
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15
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Roles of F-18-Fluoro-2-Deoxy-Glucose PET/Computed Tomography Scans in the Management of Post-Transplant Lymphoproliferative Disease in Pediatric Patient. PET Clin 2020; 15:309-319. [PMID: 32498987 DOI: 10.1016/j.cpet.2020.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Post-transplant lymphoproliferative disease is a well-known complication in transplant recipients. Evaluating the extent and stage of disease is important for management and follow-up. As a combination of anatomic and functional imaging, PET/CT is a sensitive and specific tool to stage and detect occult disease compared with conventional imaging. PET/CT also has a role in monitoring treatment response. Although PET/CT has been shown to be potentially useful in adults, evidence in children is insufficient. This review provides an overview of the use of PET/CT in post-transplant lymphoproliferative disease, especially in pediatric patients.
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16
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Seo E, Kim J, Oh SH, Kim KM, Kim DY, Lee J. Epstein-Barr viral load monitoring for diagnosing post-transplant lymphoproliferative disorder in pediatric liver transplant recipients. Pediatr Transplant 2020; 24:e13666. [PMID: 32067332 DOI: 10.1111/petr.13666] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 12/26/2019] [Accepted: 12/30/2019] [Indexed: 11/28/2022]
Abstract
This study aimed to investigate the incidence of PTLD in pediatric liver transplant recipients and the risk factors for the development of PTLD. We also determined clinically useful quantitative EBV PCR parameters for aiding in the diagnosis of EBV-associated PTLD in the pediatric liver transplant recipients at our institute. We reviewed children < 18 years old who had undergone liver transplantations and quantitative analysis of whole blood EBV load at our institute from January 2006 to March 2015. A total of 142 liver transplant recipients were included, and their median age was 1.5 years. Clinically significant high-level EBV DNAemia ≥ 10 000 copies/mL at least twice was observed in 53.5% and PTLD occurred in 9.9%. Among PTLD group, graft failure and mortality rate were as high as 21.4% and 14.3%, respectively. Deceased donor, presence of high-level EBV DNAemia, and primary CMV infection following transplant were associated with an increased risk for PTLD in the multivariate analysis. The peak titer at 10 875 copies/mL could be used as a cutoff value with a sensitivity of 92.9% and a specificity of 37.9%; the rate of increase in EBV load suggested a sensitivity of 64.3% and a specificity of 70.9% at the cutoff value of 44 000 copies/mL/week. In conclusion, the incidence of PTLD following liver transplant in children was as high as 10%. PTLD is associated with significant morbidity and mortality. Close monitoring of EBV DNAemia is crucial for the early diagnosis and proper treatment of PTLD in pediatric liver transplant recipients.
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Affiliation(s)
- Euri Seo
- Department of Pediatrics, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang, South Korea.,Department of Pediatric, University of Ulsan College of Medicine, Asan Medical Center Children's Hospital, Seoul, South Korea
| | - Joonil Kim
- Department of Pediatric, University of Ulsan College of Medicine, Asan Medical Center Children's Hospital, Seoul, South Korea
| | - Seak Hee Oh
- Department of Pediatric, University of Ulsan College of Medicine, Asan Medical Center Children's Hospital, Seoul, South Korea
| | - Kyung Mo Kim
- Department of Pediatric, University of Ulsan College of Medicine, Asan Medical Center Children's Hospital, Seoul, South Korea
| | - Dae Yeon Kim
- Department of Pediatric Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jina Lee
- Department of Pediatric, University of Ulsan College of Medicine, Asan Medical Center Children's Hospital, Seoul, South Korea
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17
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Ballard DH, Mazaheri P, Oppenheimer DC, Lubner MG, Menias CO, Pickhardt PJ, Middleton WD, Mellnick VM. Imaging of Abdominal Wall Masses, Masslike Lesions, and Diffuse Processes. Radiographics 2020; 40:684-706. [PMID: 32330085 DOI: 10.1148/rg.2020190170] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Abdominal wall masses, masslike lesions, and diffuse processes are common and often incidental findings at cross-sectional imaging. Distinguishing among these types of masses on the basis of imaging features alone can be challenging. The authors present a diagnostic algorithm that may help in distinguishing different types of abdominal wall masses accurately. Hernias may mimic discrete masses at clinical examination, and imaging is often ordered for evaluation of a possible abdominal wall mass. Once a discrete mass is confirmed to be present, the next step is to determine if it is a fat-containing, cystic, or solid mass. The most common fat-containing masses are lipomas. Fluid or cystic masses include postoperative abscesses, seromas, and rectus sheath hematomas. Solid masses are the most common abdominal wall masses and include desmoid tumors, sarcomas, endometriomas, and metastases. Multiple masses and other diffuse abdominal wall processes are often manifestations of an underlying condition or insult. The most frequently found diffuse processes are multiple injection granulomas from administration of subcutaneous medication. This article offers an algorithmic approach to characterizing abdominal wall masses on the basis of their composition and reviews abdominal wall diffuse processes. Online supplemental material is available for this article. ©RSNA, 2020.
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Affiliation(s)
- David H Ballard
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110 (D.H.B., P.M., W.D.M., V.M.M.); Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY (D.C.O.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L., P.J.P.); and Department of Radiology, Mayo Clinic Scottsdale, Scottsdale, Ariz (C.O.M.)
| | - Parisa Mazaheri
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110 (D.H.B., P.M., W.D.M., V.M.M.); Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY (D.C.O.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L., P.J.P.); and Department of Radiology, Mayo Clinic Scottsdale, Scottsdale, Ariz (C.O.M.)
| | - Daniel C Oppenheimer
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110 (D.H.B., P.M., W.D.M., V.M.M.); Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY (D.C.O.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L., P.J.P.); and Department of Radiology, Mayo Clinic Scottsdale, Scottsdale, Ariz (C.O.M.)
| | - Meghan G Lubner
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110 (D.H.B., P.M., W.D.M., V.M.M.); Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY (D.C.O.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L., P.J.P.); and Department of Radiology, Mayo Clinic Scottsdale, Scottsdale, Ariz (C.O.M.)
| | - Christine O Menias
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110 (D.H.B., P.M., W.D.M., V.M.M.); Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY (D.C.O.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L., P.J.P.); and Department of Radiology, Mayo Clinic Scottsdale, Scottsdale, Ariz (C.O.M.)
| | - Perry J Pickhardt
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110 (D.H.B., P.M., W.D.M., V.M.M.); Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY (D.C.O.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L., P.J.P.); and Department of Radiology, Mayo Clinic Scottsdale, Scottsdale, Ariz (C.O.M.)
| | - William D Middleton
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110 (D.H.B., P.M., W.D.M., V.M.M.); Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY (D.C.O.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L., P.J.P.); and Department of Radiology, Mayo Clinic Scottsdale, Scottsdale, Ariz (C.O.M.)
| | - Vincent M Mellnick
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110 (D.H.B., P.M., W.D.M., V.M.M.); Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY (D.C.O.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (M.G.L., P.J.P.); and Department of Radiology, Mayo Clinic Scottsdale, Scottsdale, Ariz (C.O.M.)
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18
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Manzia TM, Angelico R, Gazia C, Lenci I, Milana M, Ademoyero OT, Pedini D, Toti L, Spada M, Tisone G, Baiocchi L. De novo malignancies after liver transplantation: The effect of immunosuppression-personal data and review of literature. World J Gastroenterol 2019; 25:5356-5375. [PMID: 31558879 PMCID: PMC6761240 DOI: 10.3748/wjg.v25.i35.5356] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 08/08/2019] [Accepted: 08/24/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Immunosuppression has undoubtedly raised the overall positive outcomes in the post-operative management of solid organ transplantation. However, long-term exposure to immunosuppression is associated with critical systemic morbidities. De novo malignancies following orthotopic liver transplants (OLTs) are a serious threat in pediatric and adult transplant individuals. Data from different experiences were reported and compared to assess the connection between immunosuppression and de novo malignancies in liver transplant patients.
AIM To study the role of immunosuppression on the incidence of de novo malignancies in liver transplant recipients.
METHODS A systematic literature examination about de novo malignancies and immunosuppression weaning in adult and pediatric OLT recipients was described in the present review. Worldwide data were collected from highly qualified institutions performing OLTs. Patient follow-up, immunosuppression discontinuation and incidence of de novo malignancies were reported. Likewise, the review assesses the differences in adult and pediatric recipients by describing the adopted immunosuppression regimens and the different type of diagnosed solid and blood malignancy.
RESULTS Emerging evidence suggests that the liver is an immunologically privileged organ able to support immunosuppression discontinuation in carefully selected recipients. Malignancies are often detected in liver transplant patients undergoing daily immunosuppression regimens. Post-transplant lymphoproliferative diseases and skin tumors are the most detected de novo malignancies in the pediatric and adult OLT population, respectively. To date, immunosuppression withdrawal has been achieved in up to 40% and 60% of well-selected adult and pediatric recipients, respectively. In both populations, a clear benefit of immunosuppression weaning protocols on de novo malignancies is difficult to ascertain because data have not been specified in most of the clinical experiences.
CONCLUSION The selected populations of tolerant pediatric and adult liver transplant recipients greatly benefit from immunosuppression weaning. There is still no strong clinical evidence on the usefulness of immunosuppression withdrawal in OLT recipients on malignancies. An interesting focus is represented by the complete reconstitution of the immunological pathways that could help in decreasing the incidence of de novo malignancies and may also help in treating liver transplant patients suffering from cancer.
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Affiliation(s)
- Tommaso Maria Manzia
- HPB and Transplant Unit, Department of Surgery, University of Rome Tor Vergata, Rome 00133, Italy
| | - Roberta Angelico
- Division of Abdominal Transplantation and HPB Surgery, Bambino Gesù Children's Hospital IRCCS, Rome 00165, Italy
| | - Carlo Gazia
- HPB and Transplant Unit, Department of Surgery, University of Rome Tor Vergata, Rome 00133, Italy
- Wake Forest Institute for Regenerative Medicine, Winston-Salem, NC 27101, United States
| | - Ilaria Lenci
- Hepatology and Liver Transplant Unit, University of Tor Vergata, Rome 00133, Italy
| | - Martina Milana
- Hepatology and Liver Transplant Unit, University of Tor Vergata, Rome 00133, Italy
| | | | - Domiziana Pedini
- Division of Abdominal Transplantation and HPB Surgery, Bambino Gesù Children's Hospital IRCCS, Rome 00165, Italy
| | - Luca Toti
- HPB and Transplant Unit, Department of Surgery, University of Rome Tor Vergata, Rome 00133, Italy
| | - Marco Spada
- Division of Abdominal Transplantation and HPB Surgery, Bambino Gesù Children's Hospital IRCCS, Rome 00165, Italy
| | - Giuseppe Tisone
- HPB and Transplant Unit, Department of Surgery, University of Rome Tor Vergata, Rome 00133, Italy
| | - Leonardo Baiocchi
- Hepatology and Liver Transplant Unit, University of Tor Vergata, Rome 00133, Italy
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19
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Montes de Jesus FM, Kwee TC, Kahle XU, Nijland M, van Meerten T, Huls G, Dierckx RAJO, Rosati S, Diepstra A, van der Bij W, Verschuuren EAM, Glaudemans AWJM, Noordzij W. Diagnostic performance of FDG-PET/CT of post-transplant lymphoproliferative disorder and factors affecting diagnostic yield. Eur J Nucl Med Mol Imaging 2019; 47:529-536. [PMID: 31444510 PMCID: PMC7005092 DOI: 10.1007/s00259-019-04481-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 08/07/2019] [Indexed: 02/07/2023]
Abstract
Purpose Post-transplant lymphoproliferative disorder (PTLD) is a serious complication after solid organ and hematopoietic stem cell transplantation, requiring a timely and accurate diagnosis. In this study, we evaluated the diagnostic performance of FDG-PET/CT in patients with suspected PTLD and examined if lactate dehydrogenase (LDH) levels, Epstein-Barr virus (EBV) load, or timing of FDG-PET/CT relate to detection performance of FDG-PET/CT. Methods This retrospective study included 91 consecutive patients with clinical suspicion of PTLD and a total of 97 FDG-PET/CT scans within an 8-year period. Pathology reports and a 2-year follow-up were used as the reference standard. Diagnostic performance of FDG-PET/CT for detection of PTLD as well as logistic regression analysis for factors expected to affect diagnostic yield were assessed. Results The diagnosis of PTLD was established in 34 patients (35%). Fifty-seven FDG-PET/CT scans (59%) were true negative, 29 (30%) were true positive, 6 (6%) false positive, and 5 (5%) false negative. Sensitivity of FDG-PET/CT for the detection of PTLD was 85%, specificity 90%, positive predictive value 83%, and negative predictive value 92%, with good inter-observer variability (k = 0.78). Of the parameters hypothesized to be associated with a true positive FDG-PET/CT result for the diagnosis of PTLD, only LDH was statistically significant (OR 1.03, p = 0.04). Conclusion FDG-PET/CT has a good diagnostic performance in patients suspected of PTLD, with a good inter-observer agreement. Only LDH levels seemed to influence the detection performance of FDG-PET/CT. EBV-DNA load and timing of FDG-PET/CT after transplantation did not affect FDG-PET/CT diagnostic yield.
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Affiliation(s)
- F M Montes de Jesus
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Hanzeplein 1, Groningen, 9700 RB, The Netherlands.
| | - T C Kwee
- Department of Radiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - X U Kahle
- Department of Hematology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - M Nijland
- Department of Hematology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - T van Meerten
- Department of Hematology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - G Huls
- Department of Hematology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - R A J O Dierckx
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Hanzeplein 1, Groningen, 9700 RB, The Netherlands
| | - S Rosati
- Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - A Diepstra
- Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - W van der Bij
- Department of Pulmonary Diseases and tuberculosis, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - E A M Verschuuren
- Department of Pulmonary Diseases and tuberculosis, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - A W J M Glaudemans
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Hanzeplein 1, Groningen, 9700 RB, The Netherlands
| | - W Noordzij
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Hanzeplein 1, Groningen, 9700 RB, The Netherlands
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20
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Van Keerberghen CA, Goffin K, Vergote V, Tousseyn T, Verhoef G, Laenen A, Vandenberghe P, Dierickx D, Gheysens O. Role of interim and end of treatment positron emission tomography for response assessment and prediction of relapse in posttransplant lymphoproliferative disorder. Acta Oncol 2019; 58:1041-1047. [PMID: 31035840 DOI: 10.1080/0284186x.2019.1598622] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background: Fluorine-18-fluorodeoxyglucose positron emission tomography (PET) has an established and central role in diagnosis, staging and response evaluation of lymphoproliferative diseases. It has shown a high sensitivity and specificity at diagnosis in posttransplant lymphoproliferative disorders (PTLDs). However, little is known about the performance of interim and end of treatment (EOT) PET in PTLD patients with regards to response assessment, relapse prediction and outcome. Methods: We performed a single-center retrospective study in which we analyzed consecutive patients diagnosed with CD20-positive PTLD after solid organ transplantation between 2008 and 2017, who all received risk-stratified sequential treatment according to the PTLD-1 phase II trial. Interim and EOT PET studies were scored according to the Deauville criteria. Results: Forty-one patients were included with median follow-up of 41.5 months (range 1-108). Positive and negative predictive values for disease recurrence were 13% and 85% for interim and 33% and 87% for EOT PET, respectively. There was no significant difference in overall survival, progression-free survival nor time to progression between negative versus positive patients on interim and EOT scans. Conclusions: Negative interim and/or negative end of treatment PET identify PTLD patients with low risk of disease recurrence.
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Affiliation(s)
| | - Karolien Goffin
- Department of Nuclear Medicine and Molecular Imaging, University Hospitals Leuven, Leuven, Belgium
| | - Vibeke Vergote
- Department of Haematology, University Hospitals Leuven, Leuven, Belgium
| | - Thomas Tousseyn
- Department of Pathology, University Hospitals Leuven, Leuven, Belgium
| | - Gregor Verhoef
- Department of Haematology, University Hospitals Leuven, Leuven, Belgium
| | - Annouschka Laenen
- Interuniversity Institute for Biostatistics and Statistical Bioinformatics, Leuven, Belgium
| | | | - Daan Dierickx
- Department of Haematology, University Hospitals Leuven, Leuven, Belgium
| | - Olivier Gheysens
- Department of Nuclear Medicine and Molecular Imaging, University Hospitals Leuven, Leuven, Belgium
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21
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Performance of advanced imaging modalities at diagnosis and treatment response evaluation of patients with post-transplant lymphoproliferative disorder: A systematic review and meta-analysis. Crit Rev Oncol Hematol 2018; 132:27-38. [DOI: 10.1016/j.critrevonc.2018.09.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 07/20/2018] [Accepted: 09/11/2018] [Indexed: 01/03/2023] Open
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22
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A review of adenotonsillar hypertrophy and adenotonsillectomy in children after solid organ transplantation. Int J Pediatr Otorhinolaryngol 2018; 114:29-35. [PMID: 30262363 DOI: 10.1016/j.ijporl.2018.08.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 08/16/2018] [Accepted: 08/17/2018] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Paediatric solid organ transplantation is an increasingly successful treatment. Improved survival is paralleled by increased secondary complications of immunosuppression, including post-transplant lymphoproliferative disease (PTLD). PTLD frequently presents in Waldeyer's lymphatic ring. Adenotonsillar hypertrophy (ATH) is common in children, however in children after transplant, ATH may indicate PTLD. We review the literature on ATH and the role of adenotonsillectomy in children after transplantation. METHODS A comprehensive literature search was performed on the 26 th September 2017 of Ovid Medline (1996-September 2017), Embase (1996-2017) and EBM reviews (Cochrane database of systematic reviews 2005-September 20 th 2017). Results were limited to English language publications within the last 20 years. Abstracts were screened for relevance to PTLD and ATH in the paediatric solid organ transplantation population. Screening of the bibliographies identified further articles. RESULTS 85 unique articles were screened to yield 18 relevant publications. 10 were retrospective studies and 8 were prospective studies. CONCLUSION In children, we report a PTLD incidence of up to 15%, with up to 63% of cases presenting in the head and neck. Histological examination of adenotonsillectomy specimens found PTLD in a mean 5.7% (range 0-39%). We found a lack of prospective studies into this topic and further high quality research is needed. Clinical assessment of ATH in children after transplantation and when to perform a diagnostic adenotonsillectomy remains challenging. Children with ATH warrant prompt further investigation and support from colleagues in transplantation and oncology is required. .
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23
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Rahatli S, Altundag O, Ayvazoglu Soy E, Moray G, Haberal M. Posttransplant Malignancies in Adult Renal and Hepatic Transplant Patients. EXP CLIN TRANSPLANT 2018; 18:470-473. [PMID: 30119617 DOI: 10.6002/ect.2018.0177] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES The risk of some cancer types increases after organ transplant compared with that shown in the general population; this has been well documented in clinical studies. With patients having longer survival and with the higher number of transplant procedures, cancer is an increasing health concern at high-volume transplant centers. Malignancy has an important effect on short- and long-term graft and patient survival. In this study, we evaluated cancer frequency during transplant patient follow-up. MATERIALS AND METHODS This single-center retrospective study included patients who underwent solid-organ transplant at the Baskent University Medical Faculty Hospital from 1997 to 2017. Renal and hepatic transplant patients older than 16 years at the time of transplant and diagnosed with cancer after transplant were included the study. In total, 1176 of 2018 renal transplant recipients and 274 of 548 hepatic transplant recipients met the inclusion criteria. RESULTS We determined that 52 of 1176 renal transplant (4.5%) and 9 of 274 hepatic transplant patients (3.3%) developed posttransplant cancer during follow-up. Of 61 total patients with cancer posttransplant, 44 were males (72.1%) and 17 were females (27.9%), with median age at transplant of 39.2 years. Overall, the incidence of cancer in transplant recipients was 4.2%. The most frequent cancers were basal and squamous skin cancers, which were seen in 18 patients (29%), and Kaposi sarcoma, which was seen in 11 patients (18%). Of the 61 patients who developed cancer, 43 (70%) were still alive at the time of this study. CONCLUSIONS Despite recent positive developments in the use of immunosuppressive drugs, posttransplant malignancy is still a health problem. Fortunately, most cancers in this patient group have good prognosis and can be cured by surgical resection. Transplant physicians should aim for early detection of these diseases.
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Affiliation(s)
- Samed Rahatli
- Department of Medical Oncology, Baskent University Faculty of Medicine, Ankara, Turkey
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24
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National survey of de novo malignancy after solid organ transplantation in Japan. Surg Today 2018; 48:618-624. [DOI: 10.1007/s00595-018-1628-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Accepted: 01/18/2018] [Indexed: 02/06/2023]
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25
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Risk Factors and Outcomes of De Novo Cancers (Excluding Nonmelanoma Skin Cancer) After Liver Transplantation for Primary Sclerosing Cholangitis. Transplantation 2017; 101:1859-1866. [PMID: 28272287 DOI: 10.1097/tp.0000000000001725] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Patients with primary sclerosing cholangitis (PSC) may be at higher risk of malignancy after liver transplantation (LT) compared to other LT recipients. We aimed to determine the cumulative incidence of/risk factors for long-term cancer-related mortality in patients with PSC after LT. METHODS All adult patients underwent LT for PSC without cholangiocarcinoma from 1984 to 2012, with follow-up through June 2015. We estimated cumulative incidence, risk factors, and mortality from de novo malignancies after LT. RESULTS Two hundred ninety-three patients were identified (mean [SD] age, 47 [12] years; 63.3% males; 2.4% smoking at LT). Over a median of 11.5 years (range, 6.4-18.6 years), 64 patients (21.8%) developed 73 nonskin cancers, including 46 solid-organ cancers (renal, 11; colorectal, 11; prostate, 7; breast, 5; pancreas, 5; ovarian/endometrial/vulvar cancers, 3; and de novo cholangiocarcinoma, 4). Twenty-two patients developed hematologic malignancies (posttransplant lymphoproliferative diseases, 18; Hodgkin disease, 2; and myelodysplastic syndrome, 2). Five patients developed melanoma. The 1-, 5-, 10-, and 20-year cumulative incidences of cancer were 2.1%, 8.6%, 18.7%, and 27%, respectively. Mortality of patients with PSC who developed cancer was higher than that of patients with PSC without cancer (hazard ratio, 2.2; P < 0.01). On multivariate analysis, recipient's age and elevated pre-LT international normalized ratio were associated with increased risk of de novo (nonskin) malignancy. CONCLUSION The 10-year cumulative risk of cancer after LT for advanced-stage PSC was 18.7%, with posttransplant lymphoproliferative diseases, colorectal cancer, and renal cell cancer being the most common. Post-LT de novo nonskin cancer decreased overall posttransplant survival. Only recipient's age and elevated international normalized ratio at LT were associated with increased nonskin cancer risk.
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Damasio MB, Ording Muller LS, Piaggio G, Marks SD, Riccabona M. Imaging in pediatric renal transplantation. Pediatr Transplant 2017; 21. [PMID: 28121050 DOI: 10.1111/petr.12885] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/19/2016] [Indexed: 12/19/2022]
Abstract
Renal transplantation is the therapy of choice in children with ESKD. Radiological investigations are required in both pre- and post-transplant assessment, although there is paucity of both consensus-based statements and evidence-based imaging guidelines in pediatric renal transplantation. The phases of pediatric ESKD management that require imaging are pretransplantation recipient assessment and post-transplantation surveillance for detection of potential complications. We present suggestions for imaging algorithms for both pre- and post-transplant assessment in pediatric renal transplant recipients.
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Affiliation(s)
| | - Lil-Sofie Ording Muller
- Department of Radiology and Intervention Unit for Paediatric Radiology, Oslo University Hospital, Ullevål, Norway
| | - Giorgio Piaggio
- Department of Nephrology, Istituto Giannina Gaslini, Genoa, Italy
| | - Stephen D Marks
- Department of Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Michael Riccabona
- Division of Pediatric Radiology, Department of Radiology, University Hospital Graz, Graz, Austria
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Wareham NE, Lundgren JD, Da Cunha-Bang C, Gustafsson F, Iversen M, Johannesen HH, Kjær A, Rasmussen A, Sengeløv H, Sørensen SS, Fischer BM. The clinical utility of FDG PET/CT among solid organ transplant recipients suspected of malignancy or infection. Eur J Nucl Med Mol Imaging 2017; 44:421-431. [PMID: 27838763 PMCID: PMC5281676 DOI: 10.1007/s00259-016-3564-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Accepted: 10/28/2016] [Indexed: 12/23/2022]
Abstract
PURPOSE Solid organ transplant (SOT) recipients are at high risk of developing infections and malignancies. 18F-FDG PET/CT may enable timely detection of these diseases and help to ensure early intervention. We aimed to describe the clinical utility of FDG PET/CT in consecutive, diagnostic unresolved SOT recipients transplanted from January 2004 to May 2015. METHODS Recipients with a post-transplant FDG PET/CT performed as part of diagnostic work-up were included. Detailed chart reviews were done to extract relevant clinical information and determine the final diagnosis related to the FDG PET/CT. Based on á priori defined criteria and the final diagnosis, results from each scan were classified as true or false, and diagnostic values determined. RESULTS Among the 1,814 recipients in the cohort, 145 had an FDG PET/CT performed; 122 under the indication of diagnostically unresolved symptoms with a suspicion of malignancy or infection. The remaining (N = 23) had an FDG PET/CT to follow-up on a known disease or to stage a known malignancy. The 122 recipients underwent a total of 133 FDG PET/CT scans performed for a suspected malignancy (66 %) or an infection (34 %). Sensitivity, specificity, and positive and negative predictive values of the FDG PET/CT in diagnosing these conditions were 97, 84, 87, and 96 %, respectively. CONCLUSION FDG PET/CT is an accurate diagnostic tool for the work-up of diagnostic unresolved SOT recipients suspected of malignancy or infection. The high sensitivity and NPV underlines the potential usefulness of PET/CT for excluding malignancy or focal infections in this often complex clinical situation.
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Affiliation(s)
- Neval E Wareham
- Centre for Health and Infectious Disease Research (CHIP), Department of Infectious Diseases, Section 2100, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark.
| | - J D Lundgren
- Centre for Health and Infectious Disease Research (CHIP), Department of Infectious Diseases, Section 2100, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark
| | - C Da Cunha-Bang
- Department of Haematology, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark
| | - F Gustafsson
- Department of Cardiology, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark
| | - M Iversen
- Department of Cardiology, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark
| | - H H Johannesen
- Department of Clinical Physiology, Nuclear Medicine & PET, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark
| | - A Kjær
- Department of Clinical Physiology, Nuclear Medicine & PET, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark
| | - A Rasmussen
- Department of Surgical Gastroenterology, Rigshospitalet, Blegdamsvek 9, 2100 Copenhagen Ø, Denmark
| | - H Sengeløv
- Department of Haematology, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark
| | - S S Sørensen
- Department of Nephrology, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark
| | - B M Fischer
- Department of Clinical Physiology, Nuclear Medicine & PET, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark
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Barsoum RS, William EA, Khalil SS. Hepatitis C and kidney disease: A narrative review. J Adv Res 2017; 8:113-130. [PMID: 28149647 PMCID: PMC5272932 DOI: 10.1016/j.jare.2016.07.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 07/07/2016] [Accepted: 07/17/2016] [Indexed: 02/07/2023] Open
Abstract
Hepatitis-C (HCV) infection can induce kidney injury, mostly due to formation of immune-complexes and cryoglobulins, and possibly to a direct cytopathic effect. It may cause acute kidney injury (AKI) as a part of systemic vasculitis, and augments the risk of AKI due to other etiologies. It is responsible for mesangiocapillary or membranous glomerulonephritis, and accelerates the progression of chronic kidney disease due to other causes. HCV infection increases cardiovascular and liver-related mortality in patients on regular dialysis. HCV-infected patients are at increased risk of acute post-transplant complications. Long-term graft survival is compromised by recurrent or de novo glomerulonephritis, or chronic transplant glomerulopathy. Patient survival is challenged by increased incidence of diabetes, sepsis, post-transplant lymphoproliferative disease, and liver failure. Effective and safe directly acting antiviral agents (DAAs) are currently available for treatment at different stages of kidney disease. However, the relative shortage of DAAs in countries where HCV is highly endemic imposes a need for treatment-prioritization, for which a scoring system is proposed in this review. It is concluded that the thoughtful use of DAAs, will result in a significant change in the epidemiology and clinical profiles of kidney disease, as well as improvement of dialysis and transplant outcomes, in endemic areas.
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Affiliation(s)
- Rashad S. Barsoum
- Kasr-El-Aini Medical School, Cairo University, Cairo, Egypt
- The Cairo Kidney Center, Cairo, Egypt
| | - Emad A. William
- The Cairo Kidney Center, Cairo, Egypt
- National Research Centre, Cairo, Egypt
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Kumar D, Ferreira VH, Campbell P, Hoschler K, Humar A. Heterologous Immune Responses to Influenza Vaccine in Kidney Transplant Recipients. Am J Transplant 2017; 17:281-286. [PMID: 27402204 DOI: 10.1111/ajt.13960] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 06/22/2016] [Accepted: 07/03/2016] [Indexed: 01/25/2023]
Abstract
Influenza vaccine is known to have suboptimal immunogenicity in transplant recipients. Despite this, influenza vaccine may have the added benefit of inducing a cross-reactive immune response to viral strains not found in the vaccine. This is termed "heterologous immunity" and has not been assessed previously in transplant patients. Pre- and postvaccination sera from kidney transplant recipients (n = 60) immunized with the 2012-2013 adjuvanted or nonadjuvanted influenza vaccine underwent testing by hemagglutination inhibition assay for strains not present in vaccine: A/New Caledonia/20/99 (H1N1), A/Texas/50/2012 (H3N2) and B/Brisbane/60/2008. The geometric mean titer of antibody to heterologous strains increased after vaccine (H1N1: 80.0 to 136.1, p < 0.001; H3N2: 23.3 to 77.3, p < 0.001; B: 13.3 to 19.5, p < 0.001). Seroconversion rates were 16.7%, 41.7%, and 13.3%, respectively. No differences in heterologous response were seen in the adjuvanted versus nonadjuvanted groups. Patients were more likely to seroconvert for a cross-reactive antigen if they seroconverted for the specific vaccine antigen. Seroconversion to heterologous A/H3N2, for example, was 84.0% for homologous H3N2 seroconverters versus 11.4% for nonseroconverters (p < 0.001). This study provides novel evidence that transplant recipients are able to mount significant cross-protective responses to influenza vaccine that may be an additional, previously unknown benefit of immunization.
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Affiliation(s)
- D Kumar
- Multi-Organ Transplant Program, University Health Network, Toronto, Canada
| | - V H Ferreira
- Multi-Organ Transplant Program, University Health Network, Toronto, Canada
| | - P Campbell
- Department of Medicine, University of Alberta, Edmonton, Canada
| | | | - A Humar
- Multi-Organ Transplant Program, University Health Network, Toronto, Canada
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Le J, Durand CM, Agha I, Brennan DC. Epstein-Barr virus and renal transplantation. Transplant Rev (Orlando) 2016; 31:55-60. [PMID: 28089555 DOI: 10.1016/j.trre.2016.12.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 12/12/2016] [Accepted: 12/25/2016] [Indexed: 01/22/2023]
Abstract
Epstein-Barr virus (EBV) is a gamma herpesvirus associated with diseases ranging from asymptomatic viremia to post-transplant malignancies in kidney transplant recipients. EBV specifically is associated with post-transplantation lymphoproliferative disorder (PTLD), in kidney transplant recipients, with increased risk in EBV seronegative patients with EBV seropositive donors on intensified immunosuppression. The diagnosis of PTLD relies on clinical suspicion plus tissue biopsy with polymerase chain reaction (PCR) testing of blood currently used for risk determination in high-risk recipients. Therapeutic strategies for PTLD include reduction of immunosuppression, chemotherapy and rituximab, and consideration of sirolimus-based immunosuppression. Antivirals such as ganciclovir are used to prevent reactivation of cytomegalovirus and other herpes viruses but are not onco-therapeutic. Radiation therapy or surgery is indicated for bulky, disseminated or recalcitrant disease. Prognosis varies depending on the type of malignancy identified and stage of disease.
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Affiliation(s)
- Jade Le
- University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390, United States
| | - Christine M Durand
- Johns Hopkins Medical Institute, 1830 East Monument Street, Room 450D, Baltimore, MD 21287, United States
| | - Irfan Agha
- Dallas Renal Group, 3571 W. Wheatland Road, Suite 101, Dallas, TX 75237, United States
| | - Daniel C Brennan
- Washington University School of Medicine, 660 S Euclid Ave, St. Louis, MO 63110, United States.
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Muller N, Kessler R, Caillard S, Epailly E, Hubelé F, Heimburger C, Namer IJ, Herbrecht R, Blondet C, Imperiale A. 18F-FDG PET/CT for the Diagnosis of Malignant and Infectious Complications After Solid Organ Transplantation. Nucl Med Mol Imaging 2016; 51:58-68. [PMID: 28250859 DOI: 10.1007/s13139-016-0461-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2016] [Revised: 11/08/2016] [Accepted: 11/08/2016] [Indexed: 02/07/2023] Open
Abstract
PURPOSE Infection and malignancy represent two common complications after solid organ transplantation, which are often characterized by poorly specific clinical symptomatology. Herein, we have evaluated the role of 18F-fluoro-2-deoxy-D-glucose (FDG) positron emission tomography/computed tomography (PET/CT) in this clinical setting. METHODS Fifty-eight consecutive patients who underwent FDG PET/CT after kidney, lung or heart transplantation were included in this retrospective analysis. Twelve patients underwent FDG PET/CT to strengthen or confirm a diagnostic suspicion of malignancies. The remaining 46 patients presented with unexplained inflammatory syndrome, fever of unknown origin (FUO), CMV or EBV seroconversion during post-transplant follow-up without conclusive conventional imaging. FDG PET/CT results were compared to histology or to the finding obtained during a clinical/imaging follow-up period of at least 6 months after PET/CT study. RESULTS Positive FDG PET/CT results were obtained in 18 (31 %) patients. In the remaining 40 (69 %) cases, FDG PET/CT was negative, showing exclusively a physiological radiotracer distribution. On the basis of a patient-based analysis, FDG PET/CT's sensitivity, specificity, PPV and NPV were respectively 78 %, 90 %, 78 % and 90 %, with a global accuracy of 86 %. FDG PET/CT was true positive in 14 patients with bacterial pneumonias (n = 4), pulmonary fungal infection (n = 1), histoplasmosis (n = 1), cutaneous abscess (n = 1), inflammatory disorder (sacroiliitis) (n = 1), lymphoma (n = 3) and NSCLC (n = 3). On the other hand, FDG PET/CT failed to detect lung bronchoalveolar adenocarcinoma, septicemia, endocarditis and graft-versus-host disease (GVHD), respectively, in four patients. FDG PET/CT contributed to adjusting the patient therapeutic strategy in 40 % of cases. CONCLUSIONS FDG PET/CT emerges as a valuable technique to manage complications in the post-transplantation period. FDG PET/CT should be considered in patients with severe unexplained inflammatory syndrome or FUO and inconclusive conventional imaging or to discriminate active from silent lesions previously detected by conventional imaging particularly when malignancy is suspected.
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Affiliation(s)
- Nastassja Muller
- Biophysics and Nuclear Medicine, Hautepierre Hospital, University Hospitals of Strasbourg, 1 Avenue Molière, Strasbourg, 67200 France
- Department of Nuclear Medicine, Haguenau Hospital, 64, avenue Prof. Rene Leriche, BP 40252, Haguenau, 67504 France
| | - Romain Kessler
- Pneumology, Nouvel Hôpital Civil, University Hospitals of Strasbourg, 1 Place de l'hôpital, Strasbourg, 67000 France
- EA 7293 Vascular and Tissular Stress in Transplantation and FMTS, Faculty of Medicine, Strasbourg, France
| | - Sophie Caillard
- Nephrology, Nouvel Hôpital Civil, University Hospitals of Strasbourg, 1 Avenue Molière, Strasbourg, 67200 France
| | - Eric Epailly
- Cardiology, Nouvel Hôpital Civil, University Hospitals of Strasbourg, 1 Place de l'hôpital, Strasbourg, 67000 France
| | - Fabrice Hubelé
- Biophysics and Nuclear Medicine, Hautepierre Hospital, University Hospitals of Strasbourg, 1 Avenue Molière, Strasbourg, 67200 France
- ICube, University of Strasbourg/CNRS (UMR 7357) and FMTS, Faculty of Medicine, Strasbourg, France
| | - Céline Heimburger
- Biophysics and Nuclear Medicine, Hautepierre Hospital, University Hospitals of Strasbourg, 1 Avenue Molière, Strasbourg, 67200 France
| | - Izzie-Jacques Namer
- Biophysics and Nuclear Medicine, Hautepierre Hospital, University Hospitals of Strasbourg, 1 Avenue Molière, Strasbourg, 67200 France
- ICube, University of Strasbourg/CNRS (UMR 7357) and FMTS, Faculty of Medicine, Strasbourg, France
| | - Raoul Herbrecht
- Oncology and Hematology, Hautepierre Hospital, University Hospitals of Strasbourg, 1 Avenue Molière, Strasbourg, 67200 France
| | - Cyrille Blondet
- Biophysics and Nuclear Medicine, Hautepierre Hospital, University Hospitals of Strasbourg, 1 Avenue Molière, Strasbourg, 67200 France
- ICube, University of Strasbourg/CNRS (UMR 7357) and FMTS, Faculty of Medicine, Strasbourg, France
| | - Alessio Imperiale
- Biophysics and Nuclear Medicine, Hautepierre Hospital, University Hospitals of Strasbourg, 1 Avenue Molière, Strasbourg, 67200 France
- ICube, University of Strasbourg/CNRS (UMR 7357) and FMTS, Faculty of Medicine, Strasbourg, France
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De novo malignancy after lung transplantation in Japan. Gen Thorac Cardiovasc Surg 2016; 64:543-8. [DOI: 10.1007/s11748-016-0672-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 06/02/2016] [Indexed: 12/16/2022]
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Singh A, Das CJ, Gupta AK, Bagchi S. Role of diffusion weighted imaging in diagnosis of post transplant lymphoproliferative disorders: Case reports and review of literature. Indian J Nephrol 2016; 26:212-5. [PMID: 27194838 PMCID: PMC4862269 DOI: 10.4103/0971-4065.163430] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Post transplant lymphoproliferative disorder include a spectrum of conditions occurring in immunosuppressed post transplant recipients, lymphoma being the most ominous. 18F-fludeoxyglucose positron emission tomography with computed tomography CT) is the current imaging gold standard for lymphoma imaging as it allows both morphological and functional assessment. CT and/or conventional magnetic resonance imaging (MRI) are used for morphological evaluation in transplant recipients. Integrating diffusion weighted imaging with apparent diffusion coefficient analysis in MRI protocol enhances its sensitivity and may prove invaluable in response assessment in transplant recipients.
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Affiliation(s)
- A Singh
- Department of Radiology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - C J Das
- Department of Radiology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - A K Gupta
- Department of Radiology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - S Bagchi
- Department of Nephrology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
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Lewis S, Harber M, Fernando B, Banga N. Rapid and Early Diagnosis of Posttransplant Lymphoproliferative Disease Using Cross-Sectional Nuclear Medicine Imaging and Laparoscopic Lymph Node Biopsy: A Report of 2 Cases. EXP CLIN TRANSPLANT 2016; 15:470-473. [PMID: 26744227 DOI: 10.6002/ect.2015.0012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Posttransplant lymphoproliferative disease is a complication of organ transplant with a myriad clinical and anatomic manifestations, thus making diagnosis difficult without histologic confirmation. In cases of lymphadenopathy confined to the abdomen, the diagnosis can be delayed because of late presentation and difficulty obtaining a tissue for histologic analyses. We describe the use of cross-sectional nuclear medicine imaging to locate enlarged abdominal lymph nodes; this facilitated minimally invasive laparoscopic lymph node excision biopsy to rapidly diagnose 2 cases of post-transplant lymphoproliferative disease. Prompt diagnosis has enabled early effective treatment, resulting in good patient outcomes.
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Affiliation(s)
- Sarah Lewis
- From the Royal Free London NHS Foundation Trust Renal Transplant Department, United Kingdom
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Carenco C, Faure S, Ursic-Bedoya J, Herrero A, Pageaux GP. Solid, non-skin, post-liver transplant tumors: Key role of lifestyle and immunosuppression management. World J Gastroenterol 2016; 22:427-434. [PMID: 26755888 PMCID: PMC4698505 DOI: 10.3748/wjg.v22.i1.427] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 11/13/2015] [Indexed: 02/06/2023] Open
Abstract
Liver transplantation has been the treatment of choice for end-stage liver disease since 1983. Cancer has emerged as a major long-term cause of death for liver transplant recipients. Many retrospective studies that have explored standardized incidence ratio have reported increased rates of solid organ cancers post-liver transplantation; some have also studied risk factors. Liver transplantation results in a two to five-fold mean increase in the rate of solid organ cancers. Risk of head and neck, lung, esophageal, cervical cancers and Kaposi’s sarcoma is high, but risk of colorectal cancer is not clearly demonstrated. There appears to be no excess risk of developing breast or prostate cancer. Environmental risk factors such as viral infection and tobacco consumption, and personal risk factors such as obesity play a key role, but recent data also implicate the role of calcineurin inhibitors, whose cumulative and dose-dependent effects on cell metabolism might play a direct role in oncogenesis. In this paper, we review the results of studies assessing the incidence of non-skin solid tumors in order to understand the mechanisms underlying solid cancers in post-liver transplant patients and, ultimately, discuss how to prevent these cancers. Immunosuppressive protocol changes, including a calcineurin inhibitor-free regimen, combined with dietary guidelines and smoking cessation, are theoretically the best preventive measures.
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Tomasian A, Sandrasegaran K, Elsayes KM, Shanbhogue A, Shaaban A, Menias CO. Hematologic malignancies of the liver: spectrum of disease. Radiographics 2015; 35:71-86. [PMID: 25590389 DOI: 10.1148/rg.351130008] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The incidence of hematologic malignancies and their extranodal manifestations is continuously increasing. Previously unsuspected hepatic involvement in hematologic malignancies such as Hodgkin disease and non-Hodgkin lymphoma, posttransplant lymphoproliferative disorder, myeloid sarcoma (chloroma), multiple myeloma, Castleman disease, and lymphohistiocytosis may be seen by radiologists. Although the imaging features of more common hepatic diseases such as hepatocellular carcinoma, metastases, and infection may overlap with those of hepatic hematologic malignancies, combining the imaging features with clinical manifestations and laboratory findings can facilitate correct diagnosis. Clinical features that suggest a hematologic neoplasm as the cause of liver lesions include a young patient (<40 years of age), no known history of cancer, abnormal bone marrow biopsy results, fever of unknown origin, and night sweats. Imaging features that suggest hematologic malignancy include hepatosplenomegaly or splenic lesions, vascular encasement by a tumor without occlusion or thrombosis, an infiltrating mass at the hepatic hilum with no biliary obstruction, and widespread adenopathy above and below the diaphragm. Familiarity with the imaging features of hepatic hematologic malignancies permits correct provisional diagnosis and may influence therapeutic management. For example, when biopsy is performed, core biopsy may be needed in addition to fine-needle aspiration so that the tissue architecture of the neoplasm can be discerned. The predominant treatment of hematologic malignancies is chemotherapy or radiation therapy rather than surgery. Online supplemental material is available for this article.
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Affiliation(s)
- Anderanik Tomasian
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110 (A.T., C.O.M.); Department of Radiology, Indiana University School of Medicine, Indianapolis, Ind (K.S.); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.); Department of Radiology, University of Texas Health Science Center at San Antonio, San Antonio, Tex (A. Shanbhogue); and Department of Radiology, University of Utah, Salt Lake City, Utah (A. Shaaban)
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Sandrasegaran K, Menias CO, Verma S, Abdelbaki A, Shaaban A, Elsayes KM. Imaging features of haematological malignancies of kidneys. Clin Radiol 2015; 71:195-202. [PMID: 26688550 DOI: 10.1016/j.crad.2015.11.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Revised: 06/02/2015] [Accepted: 11/10/2015] [Indexed: 11/26/2022]
Abstract
Haematological malignancies are relatively uncommon neoplasms of kidneys. Nevertheless, the incidence of these neoplasms is increasing, partly due to more widespread use of computed tomography and magnetic resonance imaging. This article discusses the clinical and imaging features of renal lymphoma, leukaemia, extra-osseous multiple myeloma, and post-transplant lymphoproliferative disorder. Although there is overlap of imaging features with other more common malignancies, such as transitional and renal cell cancers, the combination of imaging findings and the appropriate clinical picture should allow the radiologist to raise a provisional diagnosis of a haematological neoplasm. This has management implications including the preference for image-guided core biopsies and a shift towards medical rather than surgical therapy.
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Affiliation(s)
- K Sandrasegaran
- Department of Diagnostic Radiology, Indiana University School of Medicine, Indianapolis, IN, USA.
| | - C O Menias
- Department of Diagnostic Radiology, Mayo Clinic, Scottsdale, AZ, USA
| | - S Verma
- Department of Diagnostic Radiology, University of Cincinnati, Cincinnati, OH, USA
| | - A Abdelbaki
- Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - A Shaaban
- Department of Diagnostic Radiology, University of Utah, Salt Lake City, UT, USA
| | - K M Elsayes
- Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Sandrasegaran K, Tomasian A, Elsayes KM, Nageswaran H, Shaaban A, Shanbhogue A, Menias CO. Hematologic malignancies of the pancreas. ACTA ACUST UNITED AC 2015; 40:411-23. [PMID: 25120155 DOI: 10.1007/s00261-014-0217-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Hematologic malignancies are relatively uncommon neoplasms of abdominal soft tissue. This article discusses the clinical and imaging features of pancreatic lymphoma, pancreatic extraosseous multiple myeloma, granulocytic sarcoma (chloroma), posttransplant lymphoproliferative disorder, and Castleman disease. The combination of imaging findings and the appropriate clinical presentation should allow the radiologist to raise a provisional diagnosis of hematologic malignancy.
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Affiliation(s)
- Kumar Sandrasegaran
- Indiana University School of Medicine, 550 N University Blvd, UH 0279, Indianapolis, IN, 46202, USA,
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Carenco C, Faure S, Herrero A, Assenat E, Duny Y, Danan G, Bismuth M, Chanques G, Ursic-Bedoya J, Jaber S, Larrey D, Navarro F, Pageaux GP. Incidence of solid organ cancers after liver transplantation: comparison with regional cancer incidence rates and risk factors. Liver Int 2015; 35:1748-55. [PMID: 25488375 DOI: 10.1111/liv.12758] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Accepted: 12/04/2014] [Indexed: 02/06/2023]
Abstract
BACKGROUND & AIMS Increased rates of solid organ cancers post-liver transplantation have been reported, but the contribution of environmental factors and immunosuppressive therapy is not clear. This study's aims were to compare the incidence of de novo solid organ cancers after liver transplantation; identify risk factors independent of immunosuppressive therapy associated with these cancers; and assess the influence of calcineurin inhibitors on the appearance of these cancers. METHODS This single-centre study from 1991 to 2008 included 465 liver recipients who had survived for ≥1 year. Gross incidence rates were standardized by age and sex, using the global population as a reference. In addition, 322 of the 465 patients treated for ≥1 year with calcineurin inhibitors were studied. RESULTS Sixty-five (13.9%) of the 465 patients developed de novo solid cancers. The overall relative risk was 3.7. Significantly increased relative risks were observed for digestive, oesophageal, colorectal, oral and lung cancers, but not for genito-urinary and breast cancers. Among the 65 patients who developed solid organ cancers, 43 died (66.1%), 41 from cancer. The two independent risk factors were pretransplant smoking [P < 0.0001; odds ratio = 5.5 (.5; 12)] and obesity [P = 0.0184; odds ratio = 2.2 (1.1; 4.3)]. Of the 322 patients on calcineurin inhibitors, 55 (17%) developed de novo solid cancers. Tacrolimus exposure level was a risk factor for de novo solid cancers [P < 0.0001; OR = 15.3 (4.5; 52.2)]. CONCLUSIONS We recommend a change in immunosuppressive protocols with lifestyle/dietary guidelines and smoking cessation.
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Affiliation(s)
- Christophe Carenco
- Digestive department, Liver Transplantation Unit - Saint-Eloi Hospital, Monterpellier, France
| | - Stéphanie Faure
- Digestive department, Liver Transplantation Unit - Saint-Eloi Hospital, Monterpellier, France
| | - Astrid Herrero
- Digestive department, Liver Transplantation Unit - Saint-Eloi Hospital, Monterpellier, France
| | - Eric Assenat
- Digestive department, Liver Transplantation Unit - Saint-Eloi Hospital, Monterpellier, France
| | - Yohan Duny
- Digestive department, Liver Transplantation Unit - Saint-Eloi Hospital, Monterpellier, France
| | - Guillaume Danan
- Digestive department, Liver Transplantation Unit - Saint-Eloi Hospital, Monterpellier, France
| | - Michaël Bismuth
- Digestive department, Liver Transplantation Unit - Saint-Eloi Hospital, Monterpellier, France
| | - Gérald Chanques
- Digestive department, Liver Transplantation Unit - Saint-Eloi Hospital, Monterpellier, France
| | - José Ursic-Bedoya
- Digestive department, Liver Transplantation Unit - Saint-Eloi Hospital, Monterpellier, France
| | - Samir Jaber
- Digestive department, Liver Transplantation Unit - Saint-Eloi Hospital, Monterpellier, France
| | - Dominique Larrey
- Digestive department, Liver Transplantation Unit - Saint-Eloi Hospital, Monterpellier, France
| | - Francis Navarro
- Digestive department, Liver Transplantation Unit - Saint-Eloi Hospital, Monterpellier, France
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Metastatic Neuroendocrine Tumour in a Renal Transplant Recipient: Dual-Tracer PET-CT with (18)F-FDG and (68)Ga-DOTANOC in This Rare Setting. Nucl Med Mol Imaging 2015; 49:57-60. [PMID: 25767623 DOI: 10.1007/s13139-014-0297-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Revised: 09/02/2014] [Accepted: 09/15/2014] [Indexed: 10/24/2022] Open
Abstract
Recipients of renal transplant are at increased risk of developing various malignancies, especially post-transplant lymphoproliferative disorder (PTLD) and skin cancers. Neuroendocrine tumours (NET) of the gastrointestinal tract have not been reported in this setting. Here we describe the case of a 75-year-old male who had undergone renal transplant 8 years back and now presented with significant weight loss and backache, clinically suspected as PTLD. (18)F-Fluordeoxyglucose ((18)F-FDG) positron emission tomography-computed tomography (PET-CT) showed hypermetabolic lesions in the liver and rectum, raising the suspicion of PTLD. However, biopsy from the liver lesion showed poorly differentiated NET. (68)Ga-labelled [1,4,7,10-tetraazacyclododecane-1,4,7,10-tetraacetic acid]-1-NaI(3)-octreotide ((68)Ga-DOTANOC) PET-CT was then done, which confirmed the primary lesion in the rectum with liver metastases.
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42
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Carenco C, Assenat E, Faure S, Duny Y, Danan G, Bismuth M, Herrero A, Jung B, Ursic-Bedoya J, Jaber S, Larrey D, Navarro F, Pageaux GP. Tacrolimus and the risk of solid cancers after liver transplant: a dose effect relationship. Am J Transplant 2015; 15:678-86. [PMID: 25648361 DOI: 10.1111/ajt.13018] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Revised: 09/11/2014] [Accepted: 09/12/2014] [Indexed: 01/25/2023]
Abstract
Although increased rates of solid organ cancers have been reported following liver transplantation (LT), the impact of quantitative exposure to calcineurin inhibitors (CNI) remains unclear. We have therefore probed the relationship between the development of solid organ cancers following LT and the level of CNI exposure. This prospective single-center study was conducted between 1995 and 2008 and is based on 247 tacrolimus-treated liver transplant recipients who survived at least 1 year following surgery. The incidence of cancer was recorded, and the mean blood concentration of tacrolimus (TC) was determined at 1 and 3 years following LT. The study results indicate that 43 (17.4%) patients developed de novo solid cancers. Mean TC during the first year after LT was significantly higher in patients who developed solid organ tumors (10.3 ± 2.1 vs. 7.9 ± 1.9 ng/mL, p < 0.0001). Independent risks factors in multivariate analysis were tobacco consumption before LT (OR = 5.42; 95% CI [1.93-15.2], p = 0.0014) and mean annual TC during the first year after LT (p < 0.0001; OR = 2.01; 95% CI [1.57-2.59], p < 0.0001). Similar effects were observed in 216 patients who received tacrolimus continuously for ≥3 years. It appears therefore that CNI should be used with caution after LT, and that new immunosuppressive therapies could deliver significant clinical benefits in this regard.
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Affiliation(s)
- C Carenco
- Liver Transplantation Unit, Digestive Department, Saint Eloi University Hospital, University of Montpellier I, Montpellier, France
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43
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(18)F-FDG PET/CT in the management of patients with post-transplant lymphoproliferative disorder. Nucl Med Commun 2014; 35:276-81. [PMID: 24296883 DOI: 10.1097/mnm.0000000000000050] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVES Post-transplant lymphoproliferative disorder (PTLD) is a rare but serious complication in transplant patients. Although fluorine-18 2-fluoro-2-deoxyglucose PET and computed tomography ((18)F-FDG PET/CT) has been used for the evaluation and management of patients with PTLD, its utility has yet to be documented. We were therefore prompted to review our experience with (18)F-FDG PET/CT in PTLD. MATERIALS AND METHODS We retrospectively reviewed the records of consecutive patients who had undergone (18)F-FDG PET/CT for evaluation of PTLD from January 2004 to June 2012 at our institution. (18)F-FDG PET/CT scans were compared with other imaging modalities performed concurrently. A chart review of pertinent clinical information was also conducted. RESULTS A total of 30 patients were identified (14 female and 16 male; 1.7-76.7 years of age, average: 23.8 years). Twenty-seven participants had biopsy-proven PTLD and another three had been treated for PTLD because of high clinical suspicion of disease and positive (18)F-FDG PET/CT findings in the absence of histological diagnosis. Eighty-three percent of these PTLD patients had extranodal involvement. In 57% of the cases, (18)F-FDG PET/CT detected occult lesions not identified on other imaging modalities or suggested PTLD in equivocal lesions. The more aggressive PTLD histological subtypes demonstrated higher SUVmax compared with the less aggressive subtypes. CONCLUSION (18)F-FDG PET/CT is beneficial in the diagnostic evaluation of patients with PTLD. (18)F-FDG PET/CT has the ability to detect occult lesions not identified on other imaging modalities, particularly extranodal lesions. In addition, (18)F-FDG PET/CT may predict the PTLD subtype, as the lesions with higher pathologic grade presented with significantly higher SUVmax compared with the less aggressive forms.
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44
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Morla O, Liberge R, Arrigoni PP, Frampas E. Pulmonary nodules and masses in lung transplant recipients: clinical and CT findings. Eur Radiol 2014; 24:2183-91. [DOI: 10.1007/s00330-014-3264-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Revised: 05/09/2014] [Accepted: 05/22/2014] [Indexed: 12/21/2022]
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45
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Yoon JH, Lee S, Kim HJ, Lee JW, Min WS, Chung BH, Yang CW, Kim YS, Kim JI, Moon IS, Oh EJ, Park GS, Cho SG. Comparative analysis of post-transplant lymphoproliferative disorder after kidney transplantation versus hematopoietic stem cell transplantation. Transpl Int 2014; 27:721-32. [DOI: 10.1111/tri.12328] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Revised: 03/03/2014] [Accepted: 03/26/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Jae-Ho Yoon
- Department of Hematology; Catholic Blood and Marrow Transplantation Center; Seoul St. Mary's Hospital; The Catholic University of Korea; Seoul Korea
| | - Seok Lee
- Department of Hematology; Catholic Blood and Marrow Transplantation Center; Seoul St. Mary's Hospital; The Catholic University of Korea; Seoul Korea
| | - Hee-Je Kim
- Department of Hematology; Catholic Blood and Marrow Transplantation Center; Seoul St. Mary's Hospital; The Catholic University of Korea; Seoul Korea
| | - Jong-Wook Lee
- Department of Hematology; Catholic Blood and Marrow Transplantation Center; Seoul St. Mary's Hospital; The Catholic University of Korea; Seoul Korea
| | - Woo-Sung Min
- Department of Hematology; Catholic Blood and Marrow Transplantation Center; Seoul St. Mary's Hospital; The Catholic University of Korea; Seoul Korea
| | - Byung Ha Chung
- Division of Nephrology; Department of Internal Medicine; Seoul St. Mary's Hospital; The Catholic University of Korea; Seoul Korea
| | - Chul Woo Yang
- Division of Nephrology; Department of Internal Medicine; Seoul St. Mary's Hospital; The Catholic University of Korea; Seoul Korea
| | - Yong-Soo Kim
- Division of Nephrology; Department of Internal Medicine; Seoul St. Mary's Hospital; The Catholic University of Korea; Seoul Korea
| | - Ji-Il Kim
- Department of Surgery; College of Medicine; The Catholic University of Korea; Seoul Korea
| | - In Sung Moon
- Department of Surgery; College of Medicine; The Catholic University of Korea; Seoul Korea
| | - Eun Ji Oh
- Department of Laboratory Medicine; Seoul St. Mary's Hospital; The Catholic University of Korea College of Medicine; Seoul Korea
| | - Gyeong-Sin Park
- Department of Pathology; Seoul St. Mary's Hospital; The Catholic University of Korea College of Medicine; Seoul Korea
| | - Seok-Goo Cho
- Department of Hematology; Catholic Blood and Marrow Transplantation Center; Seoul St. Mary's Hospital; The Catholic University of Korea; Seoul Korea
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46
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47
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Florescu DF, Langnas AN, Sandkovsky U. Opportunistic viral infections in intestinal transplantation. Expert Rev Anti Infect Ther 2014; 11:367-81. [DOI: 10.1586/eri.13.25] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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48
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Hsu JW, Wingard JR. Advances in the management of viral infections. Cancer Treat Res 2014; 161:157-180. [PMID: 24706224 DOI: 10.1007/978-3-319-04220-6_5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Viral infections are common in cancer patients. The risk and severity of infection are influenced by patient, disease, treatment, and viral factors. Severe viral infections are more likely to occur in treatment regimens that are more immunosuppressive. Historically, the most frequent severe infections have been due to herpesviruses, but more recently, other pathogens, especially community respiratory and hepatitis viruses, have received increasing attention as major viral pathogens in cancer patients. Because of the new diagnostic assays and the introduction of better therapeutic options, knowledge of viral infections is important in optimizing antineoplastic therapies.
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Affiliation(s)
- Jack W Hsu
- Department of Medicine, University of Florida, 1600 SW Archer Road, PO Box 100277, Gainesville, FL, 32610, USA,
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49
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Smets F, Sokal EM. Prevention and treatment for Epstein-Barr virus infection and related cancers. Recent Results Cancer Res 2014; 193:173-190. [PMID: 24008299 DOI: 10.1007/978-3-642-38965-8_10] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Epstein-Barr virus (EBV) was the first herpes virus described as being oncogenic in humans. EBV infection is implicated in post-transplant lymphoproliferative diseases (PTLD) and several other cancers in non-immunocompromised patients, with more than 200,000 new cases per year. While prevention of PTLD is improving, mainly based on EBV monitoring and preemptive tapering of immunosuppression, early diagnosis remains the best current option for the other malignancies. Significant progress has been achieved in treatment, with decreased mortality and morbidity, but some challenges are still to face, especially for the more aggressive diseases. Possible prevention by EBV vaccination would be a more global approach of this public health problem, but further active research is needed before this goal could be reached.
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Affiliation(s)
- Françoise Smets
- Université Catholique de Louvain, Cliniques Universitaires St-Luc, Avenue Hippocrate 10/1301, 1200, Brussels, Belgium,
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50
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Vedham V, Divi RL, Starks VL, Verma M. Multiple infections and cancer: implications in epidemiology. Technol Cancer Res Treat 2013; 13:177-94. [PMID: 23919392 DOI: 10.7785/tcrt.2012.500366] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Approximately 18% of the global cancer burden has been attributed to infectious agents, with estimates ranging from 7% in developed countries to about 22% in developing countries. Chronic infections caused by the hepatitis B and C viruses, human papilloma viruses (HPV), and Helicobacter pylori (H. pylori) are reported to be responsible for approximately 15% of all human cancers. Interestingly, although many of the infectious agents that have been associated with cancer--such as HPV, Epstein-Barr virus (EBV), and H. pylori--are highly prevalent in the world, most infected individuals do not develop cancer but remain lifelong carriers. Malignancies associated with infectious agents may result from prolonged latency as a result of chronic infections. Pathogenic infections are necessary but are not sufficient for cancer initiation or progression. Cancer initiation may require additional cofactors, including secondary infections. Therefore, in patients with chronic infection with one agent, secondary co-infection with another agent may serve as an important co-factor that may cause cancer initiation and progression. Additionally, opportunistic co-infections could significantly inhibit response to cancer treatment and increase cancer mortality. Co-infections are relatively common in areas with a high prevalence of infectious agents, especially in developing countries. These co-infections can cause an imbalance in the host immune system by affecting persistence of and susceptibility to malignant infections. Several articles have been published that focus on infectious agents and cancer. In this article, we discuss the role of infectious agents in malignancies, highlight the role of multiple/co-infections in cancer etiology, and review implications for cancer epidemiology.
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Affiliation(s)
- Vidya Vedham
- Methods and Technologies Branch, Epidemiology and Genomics Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health (NIH), 6130 Executive Boulevard, Suite 5100, Bethesda, MD 20892-7324, USA.
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