THE ROLE OF ENDOSCOPY IN DIAGNOSIS OF LYMPHOPROLIFERATIVE DISORDER (LPD) IN THE GASTROINTESTINAL TRACT (GI) OF CHILDREN AFTER LIVER TRANSPLANTATION(LTx)

Abstract

156 During the last 14 years 342 children underwent liver transplant (LTx) at UCLA Medical Center. Twenty nine patients (8.5%) developed lymphoproliferative disorder (LPD). Ten (34.5%) had gastrointestinal involvement. Eight had polyclonal and two monoclonal LPD. FK506 has been used in 9 patients: in 5 it was used as an initial immunosuppressive agent, 4 others were changed to it for chronic rejection after cyclosporine failed to prevent rejection. These 4 also received OKT3. The presenting GI symptoms of LPD were: GI bleeding (5), abdominal pain (5), diarrhea (5), vomiting and dehydration (2), mouth sores(1). All were associated with two or more weeks of fever. The earliest symptoms of LPD occurred two months post-LTx. All 10 had abdominal CT which was suggestive for GI involvement in 3 (27%). Upper and lower endoscopy was done in 7. In all the esophagus was normal. Gastric involvement was diagnosed in 3 children. Two had multiple deep ulcers throughout the stomach. Endoscopically the duodenum appeared normal in all 7. There were no false positives but one false negative endoscopic diagnosis. The proximal jejunum was examined in 2 children. Endoscopic findings were multiple erosions in one patient and white patches of mucosa in the other. Retrograde ileoscopy was performed in 3. All 3 had mucosal lesions: multiple ulcers (1), white patches (1) and erosions (1). Colonic involvement was diagnosed in 6: multiple ulcers (2), patchy erythema and thickening of the cecum (1) and loss of mucosal vascular pattern with spontaneous firability(3). Conclusion: Combined upper and lower endoscopy with the multiple biopsies is the best diagnostic approach for the evaluation of gastrointestinal involvement for LPD.