Post-Transplant Lymphoproliferative Disorder: Managing the Complexities of the Pediatric Solid Organ Transplant Patient (212)

11:30 am – 12:30 pm Friday, October 29

Posttransplant lymphoproliferative disorders (PTLDs) are recognized as one of the most devastating complications following solid organ transplantation. PTLD encompasses a wide range of clinical conditions—from benign lymphoproliferation to widespread malignancies with aggressive behavior. The development of PTLDs is driven by Epstein-Barr virus in the vast majority of pediatric PTLD cases.

The care of PTLD patients is provided by a multidisciplinary team comprising members from both oncology and solid organ transplant teams. The hematology/oncology advanced practice provider (APP) must be equipped with current knowledge about PTLDs and be prepared to navigate the complexities that arise from presentation through treatment. The APP is well positioned to serve as a leader in the clinical management of these patients and provide continuity of care across teams. Up to 15% of pediatric solid organ transplant patients acquire a PTLD. The incidence varies according to the type of immunosuppression therapy used and the type of organ transplanted. PTLD cases are rising as pediatric solid organ transplantation becomes more common. Prompt diagnosis and initiation of treatment is shown to reduce mortality rates. However, early diagnosis of PTLD is often hindered by constitutional symptoms that appear like atypical infections or graft rejection. Further, the management of PTLD poses challenges to providers. Treatment aims to eradicate PTLD, while also considering the risks of organ transplant rejection, the development of life-threatening infections, and negative effects on organ function. This presentation will review prevention and surveillance strategies, risk factors, incidence, and prognosis. An interactive case series presentation will feature education regarding diagnostic evaluation, treatment, and interpretation of laboratory and imaging studies. The World Health Organization (WHO) classification for PTLD will be reviewed, along with images of pathology samples. Recent advances in PTLD research will be presented, to include novel treatment modalities such as antiviral treatment, immunotherapy, and targeted therapeutics.