A pediatric case series of catastrophic gastrointestinal complications of posttransplant lymphoproliferative disease with increasing incidence, high association with coronavirus disease 2019, higher mortality, and a plea for early endoscopy to prevent late fatal outcome

Table 1 Characteristics of our patients

Characteristic		Case number
Characteristic		Case 1	Case 2	Case 3	Case 4	Case 5
Age (years)/gender		2.5/female	2.5/female	2/male	3.5/male	5/female
Liver transplant cause		Biliary atresia	Biliary atresia	Biliary atresia	PFIC	Crigler–Najjar
Donor		Living (mother)	Living (mother)	Living (father)	Living (mother)	Living
PTLD manifestation		Fever, diarrhea	Abdominal pain, fever, diarrhea	Fever, diarrhea	Fever, diarrhea, abdominal pain	Abdominal pain, diarrhea
EBV PCR	Transplant admission	Negative	Negative	Negative	Negative	Negative
EBV PCR	PTLD admission	Positive	Positive	Positive	Positive	Positive
CMV PCR	Transplant admission	Negative	Negative	Positive	Negative	Negative
CMV PCR	PTLD admission	Negative	Negative	Positive	Negative	Positive
Tacrolimus level (ng/mL)		11.5	17.5	8.7	9.24	20
PTLD type		Monomorphic (B cell type)	Monomorphic (B cell type)	Monomorphic (B cell type)	Monomorphic (B cell type)	Monomorphic (B cell type)
Immunosuppressant regimen		Tacrolimus, prednisolone	Tacrolimus, prednisolone	Tacrolimus, prednisolone	Tacrolimus, CellCept prednisolone, everolimus	Tacrolimus, CellCept, prednisolone
Chemotherapy		Cyclophosphamide vincristine, doxorubicin, rituximab, prednisolone	Cyclophosphamide vincristine, doxorubicin, rituximab, prednisolone	Cyclophosphamide vincristine, doxorubicin, rituximab, prednisolone	Cyclophosphamide vincristine, doxorubicin, rituximab, prednisolone	Cyclophosphamide vincristine, doxorubicin, rituximab, prednisolone
F/U and outcomes		Expired	Expired	PTLD chemotherapy	Expired	PTLD chemotherapy

PTL posttransplant lymphoproliferative disease, EBV Epstein–Barr virus, CMV cytomegalovirus, PFIC progressive familial intrahepatic cholestasis

ISSN: 1752-1947