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Volume: 11 Issue: 6 December 2013 - Supplement - 2

FULL TEXT

ORAL PRESENTATION
Prevention of Posttransplant Lymphoproliferative Disease in Pediatric Patients With Liver Transplantation

Introduction: To study the effect of utilizing intravenous Ganciclovir followed by oral Valcyte on the rate of posttransplant lymphoproliferative disease (PTLD) in pediatric liver transplant recipients. Post-transplant lymphoproliferative disorders are caused by monoclonal or polyclonal proliferations of lymphocytes in patients with solid organ transplant. According to our previous report, this rate was 0.9% in pediatric patients receiving first liver grafts and immunosuppressed with Tacrolimus.

Materials and Methods: All pediatric patients who received liver transplant from March 2009 to March 2012 entered the study. The patients were divided into two groups: The first group (control) including 87 patients transplanted between March 2009 and December 2010, didn’t receive prophylactic Ganciclovir and the second group (test) including 117 patients transplanted between December 2010 and March 2012, received prophylactic Ganciclovir according to our protocol. In this interventional study, all patients in test group received Ganciclovir at the first month after transplantation. Intravenous form was used in hospital admission period and changed to oral Valcyte after discharging. EBV and CMV serology tests were checked weekly in the second month and every two weeks thereafter. The oral Valcyte was continued for two weeks after a negative result.

Immunosupression was based on Tacrolimus and Prednisolone, while Mycophenolate mofetil was added if more immunosupression was necessary.

For statistical analysis, we used SPSS 15 program. Chi-square test and Fisher’s exact test was used to examine the effect of prophylactic Ganciclovir on reduction in the rate of PTLD and reduction in the mortality caused by PTLD, respectively.

Results: The follow-up period was 20 to 41 months in control group and 6 to 21 months in test group. PTLD occurred in 12 cases in control group (10.25%) and 5 cases in test group (5.74%). This difference was not statistically significant (0.249). In spite of treatment, mortality occurred in 5 cases in PTLD cases (41.7%) in the control group while no mortality was seen in the test group (0%), but this difference was not statistically significant (0.245).

Conclusions: Although both PTLD and mortality rates are decreased using prophylactic Ganciclovir, these differences have not been significant. This may be due to small number of PTLD cases in the study, and larger studies with greater number of the patients or multicenter trials are proposed.



Volume : 11
Issue : 6
Pages : 53


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