Immunosuppression Withdrawal in Pediatric Liver Transplant Recipients with Posttransplant Lymphoproliferative Disorder: A Single-Center Retrospective Study

Background:Posttransplant lymphoproliferative disorder (PTLD) is a serious complication following pediatric liver transplantation.Reduction of immunosuppression is a cornerstone of PTLD management; however, the feasibility and safety of complete immunosuppression withdrawal (ISW) in this setting remain unclear. Material/Methods:We retrospectively reviewed 6 pediatric liver transplant recipients diagnosed with PTLD who subsequently underwent complete ISW at our center between 2013 and 2019.Demographic characteristics, clinical features, pathological classification, treatments, and follow-up outcomes were analyzed. Results:The cohort included 6 children (4 females and 2 males) who underwent liver transplantation at a median age of 8 months.PTLD subtypes included infectious mononucleosis-type (n=3), polymorphic PTLD (n=1), Burkitt lymphoma (n=1), and classical Hodgkin lymphoma-like PTLD (n=1).All patients achieved complete remission following multimodal therapy.The median interval from transplantation to initiation of ISW was 35 months.During a median follow-up of 52 months after ISW, 4 patients maintained stable graft function without biopsy-proven rejection, whereas 2 developed rejection-related complications, both of which resolved after restart of low-dose immunosuppressive therapy.No graft loss or PTLD recurrence occurred. Conclusions:In carefully selected pediatric liver transplant recipients with PTLD, supervised ISW may be achieved without irreversible graft injury.However, a substantial risk of rejection remains, highlighting the importance of close clinical and histological monitoring.