Insights into the Current Clinical Features of Posttransplant Lymphoproliferative Disorders in Pediatric Liver Transplantation

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.