Prognostic value of baseline 18F-FDG PET/CT metabolic parameters in post-transplant lymphoproliferative disorder after pediatric liver transplantation.
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BACKGROUND: Post-transplant lymphoproliferative disorder (PTLD) is a serious complication after pediatric liver transplantation (pLT). Study assessing the prognostic value of pretreatment fluorine-18-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET)/computed tomography (CT) in patients with PTLD after pLT is few. We conducted this study to evaluate the prognostic value of baseline 18F-FDG PET/CT in patients with PTLD after pLT. METHODS: In total, 42 patients with PTLD after pLT who underwent 18F-FDG PET/CT before treatment were retrospectively analyzed. All patients were pathologically diagnosed, and baseline characteristics and clinical data were collected. Metabolic parameters, including maximum standardized uptake value (SUVmax), peak standardized uptake value (SUVpeak), average standardized uptake value (SUVavg), metabolic tumor volume (MTV), total lesion glycolysis (TLG) of the lesion with the highest FDG uptake, and total MTV (tMTV), total TLG (tTLG) of whole-body lesions were measured on 18F-FDG PET/CT. The prognostic significance of clinical variables and metabolic parameters was assessed using Cox proportional hazards regression models. Progression-free survival (PFS) probability was examined using the Kaplan-Meier method. RESULTS: During a median follow-up period of 638 days (range, 57-2,354 days), 26 patients (61.9%) experienced events defined as PFS, with 25 (59.5%) experiencing recurrence or progression and 1 (2.3%) experiencing mortality attributed to non-PTLD etiology. Univariate Cox regression analysis showed that serum tacrolimus level, morphology, SUVmax, TLG, tMTV, and tTLG were significant predictors of PFS. The results of multivariate analysis revealed that tTLG [hazard ratio (HR) =4.942; 95% confidence interval (CI): 2.142-11.406; P<0.001] were significant independent predictors of PFS. CONCLUSIONS: Baseline 18F-FDG PET/CT metabolic parameters could predict the prognosis of patients with PTLD after pLT.