Post-transplant lymphoproliferative disease (PTLD) is a major complication of solid organ transplantation. PTLD occurs in 2–15% of pediatric solid organ transplant (SOT) patients, depending on the organ transplanted and the immunosuppression used (Llaurador, 2017). The incidence of transplantation in pediatrics is steadily rising making PTLD the most common form of lymphoproliferation in childhood (Llaurador, 2017). Features of PTLD are similar to an immune system malignancy with abnormal proliferation of lymphoid lineage cells, typically B cells, in the setting of immunosuppression and often associated with EBV infection (Dharnidharka, 2017). Presentation and treatment choice covers a wide spectrum. The goal is to preserve the transplanted organ/graft while eradicating the lymphoproliferative disease. Most often the first intervention is reduction of immunosuppression (Dharnidharka, 2017) and is generally managed by the transplant team. Oncology providers become a prominent member of the multidisciplinary team for patients with more aggressive or disseminated disease.
Treatment options include monoclonal antibody alone or addition of chemotherapeutic agents. Response rates of 50% have been reported with use of single-agent rituximab and EFS rates of around 70% with combination low dose chemotherapy and rituximab (Llaurador, 2017). New treatment strategies are being tested to improve these response rates. With rising incidence of pediatric transplantation, it is critical that the oncology nurse be aware of this diagnosis and treatment options to provide optimal care and education to the patient and family. This lecture will review PTLD following solid organ transplantation including risk factors, pathophysiology, clinical presentation/diagnostic workup, and treatment options. Case studies will be presented to help nurses gain a clear understanding of this disorder and treatment options so as to provide optimal care and education to the patient and family.
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