Post-transplant eosinophilic gastrointestinal disorders and lymphoproliferative disorder in pediatric liver transplant recipients on tacrolimus,Transplant Immunology

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Post-transplant eosinophilic gastrointestinal disorders and lymphoproliferative disorder in pediatric liver transplant recipients on tacrolimus
Transplant Immunology ( IF 1.6 ) Pub Date : 2021-07-25 , DOI: 10.1016/j.trim.2021.101438
Paul Wasuwanich ₁ , Irini Batsis ₂ , Supharerk Thawillarp ₃ , Mary K Alford ₂ , Douglas Mogul ₂ , Robert A Wood ₄ , Wikrom Karnsakul ₂

Affiliation

Aim

To examine and characterize post-transplant eosinophilic gastrointestinal disorders (PTEGID) and post-transplant lymphoproliferative disorder (PTLD) in pediatric liver transplant recipients.

Methods

This is a single center retrospective study of all liver transplant recipients aged 0–18 years from 1999 to 2019 who received tacrolimus as their primary immunosuppressant. Demographic data and clinical/laboratory data including PTEGID, PTLD, liver transplant types, Epstein-Barr virus status, and blood eosinophil count were reviewed. Analysis was done with logistic regression and Mann-Whitney U test.

Results

Ninety-eight pediatric liver transplant recipients were included with median age at transplantation of 3.3 years (IQR: 1.1–9.3). The major indication for transplantation was biliary atresia, 51 (52%) cases. Eight (8%) children had PTLD and 14 (14%) had PTEGID. Receiving liver transplantation at an age of ≤1 year was associated with developing PTEGID (OR = 11.9, 95% CI = 3.5–45.6, p < 0.001). Additionally, eosinophilic count of ≥500/μL was associated with having PTLD (OR = 10.7, 95% CI = 1.8–206.0, p = 0.030) as well as having at least one liver rejection (OR = 2.8, 95% CI = 1.2–7.0, p = 0.024). The frequency of food-induced anaphylaxis significantly increased post-transplantation (p = 0.023).

Conclusions

PTEGID and PTLD are common in this cohort and are associated with certain risk factors that help screen children to improve recipient survival. Further studies are needed to evaluate the clinical benefits of these findings.

中文翻译：

接受他克莫司治疗的儿童肝移植受者的移植后嗜酸性胃肠道疾病和淋巴组织增生性疾病

目标

检查和表征小儿肝移植受者的移植后嗜酸性胃肠道疾病 (PTEGID) 和移植后淋巴组织增生性疾病 (PTLD)。

方法

这是一项单中心回顾性研究，对象为 1999 年至 2019 年所有接受他克莫司作为主要免疫抑制剂的 0-18 岁肝移植受者。审查了人口学数据和临床/实验室数据，包括 PTEGID、PTLD、肝移植类型、爱泼斯坦-巴尔病毒状态和血液嗜酸性粒细胞计数。使用逻辑回归和 Mann-Whitney U检验进行分析。

结果

包括 98 名小儿肝移植受者，移植时的中位年龄为 3.3 岁（IQR：1.1-9.3）。移植的主要适应症是胆道闭锁，51 (52%) 例。8 名 (8%) 名儿童患有 PTLD，14 名 (14%) 名儿童患有 PTEGID。≤1 岁接受肝移植与发生 PTEGID 相关（OR = 11.9, 95% CI = 3.5–45.6, p < 0.001）。此外，嗜酸性粒细胞计数≥500/μL 与 PTLD（OR = 10.7, 95% CI = 1.8–206.0, p = 0.030）以及至少有一次肝脏排斥反应（OR = 2.8, 95% CI = 1.2）相关–7.0，p = 0.024）。移植后食物引起的过敏反应的频率显着增加（p = 0.023）。