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Post-transplant lymphoproliferative disease is associated with early sternotomy and left ventricular hypoplasia during infancy: a population-based retrospective review

Published online by Cambridge University Press:  07 August 2017

Britt-Marie Ekman-Joelsson Open the ORCID record for Britt-Marie Ekman-Joelsson [Opens in a new window] ,
Håkan Wåhlander ,
Mats Synnergren ,
Madeleine Sager  and
Karin Mellgren
Britt-Marie Ekman-Joelsson*
Affiliation:
Department of Pediatrics, Institution for Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
Håkan Wåhlander
Affiliation:
Department of Pediatrics, Institution for Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
Mats Synnergren
Affiliation:
Department of Pediatrics, Institution for Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
Madeleine Sager
Affiliation:
Södra Älvsborg Hospital, Borås, Sweden
Karin Mellgren
Affiliation:
Department of Pediatrics, Institution for Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
*
Correspondence to: B.-.M. Ekman-Joelsson, The Queen Silvia Children’s Hospital, Gothenburg 416 50, Sweden. Tel: +46 31 343 8377; Fax: +46 3 184 5029; E-mail: britt-mari.ekman-joelsson@vgregion.se
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Abstract

Background

Heart transplantation has been an option for children in Sweden since 1989. As our unit faced an increased rate of post-transplant lymphoproliferative disorder, the objective of the study was to identify possible risk factors.

Methods

This is a retrospective study of all children aged 0–18 years who underwent heart transplantation in Gothenburg from 1989 to 2014.

Results

A total of 71 children underwent heart transplantation. The overall incidence of post-transplant lymphoproliferative disorder was 14% (10/71); however, 17% (6/36) of those undergoing transplantation after 2007 developed lymphoma, compared with only 10% (4/35) of transplantation cases before 2007 (p=0.85). The mean age at transplantation was 9 years (0–17). The mean post-transplant follow-up time was 5.5 years (0.5–21.9) in the group that developed post-transplant lymphoproliferative disorder, compared with 10.2 years (0.02–25.2) in those who did not. In our study group, risk factors for post-transplant lymphoproliferative disorder were surgically palliated CHD (p=0.0005), sternotomy during infancy (p⩽0.0001), hypoplastic left ventricle (p=0.0001), number of surgical events (p=0.0022), mismatch concerning Epstein–Barr virus infection – that is, a positive donor–negative recipient (p⩽0.0001) – and immunosuppressive treatment with tacrolimus compared with ciclosporine (p=0.028).

Discussion

This study has three major findings. First, post-transplant lymphoproliferative disorder only developed in subjects born with CHD. Second, the vast majority (9/10) of the subjects developing the disorder had undergone sternotomy as infants. Third, the number of surgical events correlated with a higher risk for developing post-transplant lymphoproliferative disorder.

Keywords

Heart transplantationchildpost-transplant lymphoproliferative diseasesternotomyCHD
Type
Original Articles
Information
Cardiology in the Young , Volume 27 , Issue 9 , November 2017 , pp. 1823 - 1831
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Copyright
© Cambridge University Press 2017 

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