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Full text of this paper is not available in the ETD Center. Copies may be available for inter-library loan from University of Cincinnati or may be available for purchase from Proquest/UMI

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PRIMARY IMMUNOSUPPRESSION WITH TACROLIMUS AND AGE AT TRANSPLANTATION AS INDEPENDENT RISK FACTORS FOR THE DEVELOPMENT OF POST-TRANSPLANT LYMPHOPROLIFERATIVE DISEASE IN CHILDREN UNDERGOING LIVER TRANSPLANTATION

GUTHERY, STEPHEN L.
http://rave.ohiolink.edu/etdc/view?acc_num=ucin1016565901

Abstract Details

2002, MS, University of Cincinnati, Medicine : Environmental Health Sciences.
Background. Post-transplant lymphoproliferative disorder (PTLD) is a major source of morbidity and mortality following liver transplantation in children. Previous studies have suggested an increased risk of PTLD in patients treated with tacrolimus for primary immunosuppression. However, they did not adequately control for potential confounding variables. Materials and Methods. This is a historical cohort of 214 pediatric patients undergoing liver transplantation. Cases of PTLD were identified by chart review using previously published criteria. Data on independent variables were also collected by chart review. Unadjusted and adjusted hazard ratios were determined using proportional hazards regression. Results. Twenty cases of PTLD were identified, an incidence of 9.3% (95% CI: 5.4-13.2%). Significant risk factors for PTLD included primary immunosuppression with tacrolimus (RR 3.4, 95% CI: 1.25-9.22), age at transplantation (RR 0.86, 95% CI: 0.747-0.99), therapy for rejection (RR 0.4, 95%CI: 0.17-0.97), and exposure to both cyclosporine and OKT-3 (RR 0.36, 95%CI: 0.13-0.95). Following adjustment, only primary immunosuppression with tacrolimus (RR 3.0, 95%CI: 1.1-8.25) and age at transplantation (RR 0.87, 95%CI: 0.76-0.997) were identified as independent risk factors. Significantly fewer patients treated with tacrolimus than those treated with cyclosporine required OKT-3 therapy for rejection (11% vs. 24%, p=0.01). Conclusion. Primary immunosuppression with tacrolimus and age at transplantation are associated with increased risk of PTLD in children undergoing liver transplantation. Moreover, age at transplantation confounds the relationship between primary immunosuppression with tacrolimus and PTLD. Further studies must account for these when evaluating other potential risk factors for PTLD.
Dr. Richard Hornung (Advisor)
1 p.
pediatrics; liver transplantation; immunosuppression; lymphoproliferative disorder; Epstein-Barr Virus

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Citations

  • GUTHERY, S. L. (2002). PRIMARY IMMUNOSUPPRESSION WITH TACROLIMUS AND AGE AT TRANSPLANTATION AS INDEPENDENT RISK FACTORS FOR THE DEVELOPMENT OF POST-TRANSPLANT LYMPHOPROLIFERATIVE DISEASE IN CHILDREN UNDERGOING LIVER TRANSPLANTATION [Master's thesis, University of Cincinnati]. OhioLINK Electronic Theses and Dissertations Center. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1016565901

    APA Style (7th edition)

  • GUTHERY, STEPHEN. PRIMARY IMMUNOSUPPRESSION WITH TACROLIMUS AND AGE AT TRANSPLANTATION AS INDEPENDENT RISK FACTORS FOR THE DEVELOPMENT OF POST-TRANSPLANT LYMPHOPROLIFERATIVE DISEASE IN CHILDREN UNDERGOING LIVER TRANSPLANTATION. 2002. University of Cincinnati, Master's thesis. OhioLINK Electronic Theses and Dissertations Center, http://rave.ohiolink.edu/etdc/view?acc_num=ucin1016565901.

    MLA Style (8th edition)

  • GUTHERY, STEPHEN. "PRIMARY IMMUNOSUPPRESSION WITH TACROLIMUS AND AGE AT TRANSPLANTATION AS INDEPENDENT RISK FACTORS FOR THE DEVELOPMENT OF POST-TRANSPLANT LYMPHOPROLIFERATIVE DISEASE IN CHILDREN UNDERGOING LIVER TRANSPLANTATION." Master's thesis, University of Cincinnati, 2002. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1016565901

    Chicago Manual of Style (17th edition)

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© 2002, all rights reserved.
This open access ETD is published by University of Cincinnati and OhioLINK.