Immunosuppression Withdrawal in Pediatric Liver Transplant Recipients With Posttransplant Lymphoproliferative Disorder: A Single-Center Retrospective Study.
This single-center retrospective study reports that, among six pediatric liver transplant recipients with PTLD in complete remission who underwent complete immunosuppression withdrawal, four maintained stable graft function and two had reversible rejection-related complications, with no graft loss or PTLD recurrence during the reported follow-up.
Open original publication →What the AI sees
This single-center retrospective study reports that, among six pediatric liver transplant recipients with PTLD in complete remission who underwent complete immunosuppression withdrawal, four maintained stable graft function and two had reversible rejection-related complications, with no graft loss or PTLD recurrence during the reported follow-up.
Research significance
The observed outcomes provide preliminary evidence that supervised complete immunosuppression withdrawal can be feasible after PTLD remission in carefully selected pediatric liver transplant recipients; it may reduce ongoing immunosuppression exposure or PTLD-promoting pressure, but this benefit is inferential and must be weighed against the observed rejection risk.
Source abstract
BACKGROUND Posttransplant lymphoproliferative disorder (PTLD) is a serious complication following pediatric liver transplantation. Reduction of immunosuppression is a cornerstone of PTLD management; however, the feasibility and safety of complete immunosuppression withdrawal (ISW) in this setting remain unclear. MATERIAL AND METHODS We retrospectively reviewed 6 pediatric liver transplant recipients diagnosed with PTLD who subsequently underwent complete ISW at our center between 2013 and 2019. Demographic characteristics, clinical features, pathological classification, treatments, and follow-up outcomes were analyzed. RESULTS The cohort included 6 children (4 females and 2 males) who underwent liver transplantation at a median age of 8 months. PTLD subtypes included infectious mononucleosis-type (n=3), polymorphic PTLD (n=1), Burkitt lymphoma (n=1), and classical Hodgkin lymphoma-like PTLD (n=1). All patients achieved complete remission following multimodal therapy. The median interval from transplantation to initiation of ISW was 35 months. During a median follow-up of 52 months after ISW, 4 patients maintained stable graft function without biopsy-proven rejection, whereas 2 developed rejection-related complications, both of which resolved after restart of low-dose immunosuppressive therapy. No graft loss or PTLD recurrence occurred. CONCLUSIONS In carefully selected pediatric liver transplant recipients with PTLD, supervised ISW may be achieved without irreversible graft injury. However, a substantial risk of rejection remains, highlighting the importance of close clinical and histological monitoring.