EBV Predicts Post-Pediatric Heart Transplant Malignancy; Induction Therapy And Tacrolimus Donít
Katherine Giuliano, MD, Joseph K. Canner, MHS, Brandi B. Scully, MD, Nicholas Clarke, MD, Charles D. Fraser, III, MD, William Ravekes, MD, Bret Mettler, MD, Marshall Jacobs, MD, Danielle Gottlieb Sen, MD MPH MS.
Johns Hopkins, Baltimore, MD, USA.
Objective(s): Pediatric heart transplant (Htx) recipients are at risk for malignancy secondary to immunosuppression and oncogenic viral infections. Post-transplant lymphoproliferative disorder (PTLD) reportedly occurs in 5-10% of pediatric Htx patients. We examined incidence and risk factors for post-transplant malignancy using a national database. Methods:The United Network for Organ Sharing (UNOS) database was queried for pediatric (<18 years) HTx recipients (10/1987-10/2019). We performed Kaplan-Meier analysis to assess freedom from malignancy post-transplant and Cox regression to generate hazard ratios (HR [95% CI]) for risk of malignancy development.Results: Of 8,581 pediatric HTx recipients (median follow-up 6.3 years), 8.1% developed malignancy. PTLD comprised the majority (86.4%). Incidence of PTLD development was 1.3% and 4.5% at one and five years. Older age at transplant was protective against development of malignancy (HR 0.98 [0.96-0.99], p<0.001). History of previous malignancy (HR 1.9 [1.2-3.0], p=0.007) and Ebstein-Barr virus (EBV) recipient-donor mismatch (HR 1.7 [1.3-2.2], p<0.001) increased the risk. Neither induction therapy (p=0.355), utilized in 78.9%, nor maintenance tacrolimus (p=0.912) increased the risk of malignancy.Conclusions:PTLD occurred after 8% of pediatric HTx, with risk increased by younger age and EBV mismatch, highlighting the importance of PTLD monitoring in EBV seronegative recipients. Induction therapy, utilized in the majority of pediatric HTx, does not seem to increase post-transplant malignancy, nor does the most commonly used calcineurin inhibitor tacrolimus.
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