Abstract
Core Messages: The incidence, morbidity, and mortality of PTLD in liver and intestine transplantations have significantly decreased over time. Incidence of PTLD in pediatric liver transplantation is currently 2-3%, and is approaching the 1-2% rate of PTLD seen after adult liver transplantation. Improvements in immunosuppression, EBV monitoring, pre emptive therapy, and treatment have led to this reduction in incidence as well as to a concomitant reduction in mortality. The incidence of PTLD in pediatric intestine transplantation has been dramatically reduced from historical rates of 30-40% to approximately 8-10%. PTLD occurs in approximately 13% of children as compared to 5% in adults. Therapy for PTLD differs based on the transplanted organ. In liver transplantation, cessation of immunosuppression is recommended as the mainstay of therapy for PTLD. In intestinal transplantation, the extent of the lowering of immunosuppression is limited by the immunogenicity of the transplanted bowel. Antiviral therapies with ganciclovir and intravenous immune globulin (IVIG) are used in both instances. Additional therapies such as rituximab (anti CD20 antibody) and low dose chemotherapy options have significantly contributed to improved outcome after PTLD in intestine transplantation. © 2010 Springer-Verlag Berlin Heidelberg.