Post-transplant eosinophilic gastrointestinal disorders and lymphoproliferative disorder in pediatric liver transplant recipients on tacrolimus

Paul Wasuwanich; Irini Batsis; Supharerk Thawillarp; Mary K Alford; Douglas Mogul; Robert A Wood; Wikrom Karnsakul

doi:10.1016/j.trim.2021.101438

Post-transplant eosinophilic gastrointestinal disorders and lymphoproliferative disorder in pediatric liver transplant recipients on tacrolimus

Transpl Immunol. 2021 Oct:68:101438. doi: 10.1016/j.trim.2021.101438. Epub 2021 Jul 25.

Authors

Paul Wasuwanich¹, Irini Batsis², Supharerk Thawillarp³, Mary K Alford², Douglas Mogul², Robert A Wood⁴, Wikrom Karnsakul⁵

Affiliations

¹ University of Florida College of Medicine, Gainesville, FL, USA.
² Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
³ Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
⁴ Division of Pediatric Allergy and Immunology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
⁵ Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA. Electronic address: wkarnsa1@jhmi.edu.

PMID: 34320385
DOI: 10.1016/j.trim.2021.101438

Abstract

Aim: To examine and characterize post-transplant eosinophilic gastrointestinal disorders (PTEGID) and post-transplant lymphoproliferative disorder (PTLD) in pediatric liver transplant recipients.

Methods: This is a single center retrospective study of all liver transplant recipients aged 0-18 years from 1999 to 2019 who received tacrolimus as their primary immunosuppressant. Demographic data and clinical/laboratory data including PTEGID, PTLD, liver transplant types, Epstein-Barr virus status, and blood eosinophil count were reviewed. Analysis was done with logistic regression and Mann-Whitney U test.

Results: Ninety-eight pediatric liver transplant recipients were included with median age at transplantation of 3.3 years (IQR: 1.1-9.3). The major indication for transplantation was biliary atresia, 51 (52%) cases. Eight (8%) children had PTLD and 14 (14%) had PTEGID. Receiving liver transplantation at an age of ≤1 year was associated with developing PTEGID (OR = 11.9, 95% CI = 3.5-45.6, p < 0.001). Additionally, eosinophilic count of ≥500/μL was associated with having PTLD (OR = 10.7, 95% CI = 1.8-206.0, p = 0.030) as well as having at least one liver rejection (OR = 2.8, 95% CI = 1.2-7.0, p = 0.024). The frequency of food-induced anaphylaxis significantly increased post-transplantation (p = 0.023).

Conclusions: PTEGID and PTLD are common in this cohort and are associated with certain risk factors that help screen children to improve recipient survival. Further studies are needed to evaluate the clinical benefits of these findings.

Keywords: Anaphylaxis; Biliary atresia; Diarrhea; Epstein-Barr virus infections; Graft rejection.

MeSH terms

Child
Epstein-Barr Virus Infections*
Gastrointestinal Diseases*
Herpesvirus 4, Human
Humans
Liver Transplantation*
Lymphoproliferative Disorders*
Postoperative Complications
Retrospective Studies
Tacrolimus / therapeutic use

Substances

Tacrolimus