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- W4252240757 abstract "341 PTLD is a potentially fatal complication associated with EBV infection after tx. Patients at increased risk for PTLD include infants who developed primary EBV infection after tx, and patients who had been heavily immunosuppressed. Since 1994, a strategy was developed in our pediatric liver transplant program based on two principal hypotheses: 1) early detection of EBV infection by PCR and prompt treatment may prevent progression to PTLD, and 2) the risk of PTLD is reduced by avoiding high levels of immunosuppression. Immunosuppression regimen consists of oral tacrolimus and prednisone with well defined target tacrolimus trough levels. Steroid is withdrawn in most cases after 3-9 months. Antibody induction therapy is used only for selected indications. Ganciclovir is given at 5mg/kg/day intravenously for 7-14 days for CMV prophylaxis. Children under the age of three years who are at greater risk for PTLD receive anti-viral prophylaxis in the form of oral Acyclovir at 40mg/kg/day for 6 months and are screened for EBV infection by semi-quantitative EBV PCR (every 2-4 months in the first year, and once every 3-6 months for the second year) EBV serology, and PCR are assessed in all recipients who developed fever lasting for more than three days, especially if there is associated lymphadenopathy, diarrhea, GI bleeding, or stridor. CT scan, endoscopy, and laryngoscopy with biopsy are performed if indicated. Acute EBV infection is treated with reduction or stopping immunosuppression and ganciclovir. PTLD is treated by stopping immunosuppression, a 6-week course of intravenous ganciclovir and Cytogam. In this study of 184 pediatric liver tx recipients, the incidence and mortality of PTLD before and after adoption of this protocol was analyzed. Follow-up ranged from 1-7 years. TableOur experience suggests that 1) vigilance for the signs and symptoms of EBV infection and PTLD, 2) early detection of EBV infection by EBV PCR and prompt treatment, and 3) restricting the use of antibody induction and timely reduction in immunosuppression help to reduce both the incidence and severity of PTLD." @default.
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- W4252240757 date "1998-06-01" @default.
- W4252240757 modified "2023-10-14" @default.
- W4252240757 title "STRATEGY TO REDUCE THE INCIDENCE AND MORTALITY OF POSTTRANSPLANT LYMPHOPROLIFERATIVE DISEASE AFTER LIVER TRANSPLANTATION IN CHILDREN" @default.
- W4252240757 doi "https://doi.org/10.1097/00007890-199806270-00360" @default.
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