Background: Posttransplant lymphoproliferative disorders (PTLDs) are a unique set of complications following solid organ and hematopoietic stem cell transplantation, predominantly originating from CD20 + B-cells. In pediatric recipients, the long-term prognosis warrants particular consideration. Methods: To enhance our understanding of PTLD in a large cohort, we performed a retrospective analysis of 2032 pediatric recipients who underwent liver transplantation (LT) between 2006 and 2019. Results: Among the 2032 individuals, 84 (4.13%) were diagnosed with PTLD. The cumulative incidence rates were 5.9% at 5 years and 7.7% at 10 years posttransplant. The median time to PTLD onset was 15.7 (4.9–24.3) months, with the majority (78.6%) of patients developing PTLD between 3 and 18 months post-LT. Notably, the peak occurrence of pediatric PTLD cases were observed between 3 and 6 months after transplantation. In a multivariable cox regression analysis, Epstein–Barr virus infection (hazard ratio HR: 9.4559; 95% confidence interval CI: 4.612–22.818; P < 0.001) and immunosuppression with tacrolimus (HR: 6.2101; 95% CI: 1.4715–31.3545; P = 0.0151) were identified as significant risk factors. The long-term graft survival rate for PTLD patients was 85.5%. Conclusions: PTLD is a significant concern for pediatric transplant recipients, potentially affecting their quality of life. Our study highlights the necessity for enhanced prevention strategies and prompts detection, particularly during periods of elevated incidence.
Luo et al. (2026) studied this question.