Post-transplant lymphoproliferative disorder after lung transplantation: A review of 35 cases

• Published in: The Journal of heart and lung transplantation Vol. 31; no. 3; pp. 296 - 304
• Main Authors: Kremer, Brandon E., MD, PhD, Reshef, Ran, MD, Misleh, Jamal G., MD, Christie, Jason D., MD, MSCE, Ahya, Vivek N., MD, Blumenthal, Nancy P., CRNP, Kotloff, Robert M., MD, Hadjiliadis, Denis, MD, MHS, Stadtmauer, Edward A., MD, Schuster, Stephen J., MD, Tsai, Donald E., MD, PhD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.03.2012; Elsevier
• Subjects: Adult; Aged; Biological and medical sciences; Cardiology. Vascular system; Female; Follow-Up Studies; gastrointestinal tract; Gastrointestinal Tract - pathology; Hematologic and hematopoietic diseases; Humans; Immunosuppression; Incidence; Kaplan-Meier Estimate; Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis; Lung - pathology; lung transplantation; Lung Transplantation - adverse effects; Lung Transplantation - immunology; Lung Transplantation - mortality; Lymphoproliferative Disorders - epidemiology; Lymphoproliferative Disorders - mortality; Lymphoproliferative Disorders - pathology; Male; Medical sciences; Middle Aged; post-transplant lymphoproliferative disorder; PTLD; Retrospective Studies; Risk Factors; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; Survival Rate; PTLD; lung transplantation; gastrointestinal tract; post-transplant lymphoproliferative disorder; Lung; Hemopathy; Transplantation; Review; Homotransplantation; Phlebology; Case study; Treatment; Posttransplant lymphoproliferative disorder; Surgery; Lymphoproliferative syndrome; Graft; Circulatory system; Cardiology; Bibliographic review
• ISSN: 1053-2498; 1557-3117
• DOI: 10.1016/j.healun.2011.10.013

Background Post-transplant lymphoproliferative disorder (PTLD) is a complication of organ transplantation. The risk of developing PTLD varies depending on a number of factors, including the organ transplanted and the degree of immunosuppression used. Methods We report a retrospective analysis of 35 patients with PTLD treated at our center after lung transplantation. Of 705 patients who received allografts, 34 (4.8%) developed PTLD. One patient underwent transplantation elsewhere and was treated at our center. Results PTLD involved the allograft in 49% of our patients and the gastrointestinal (GI) tract lumen in 23%. Histologically, 39% of tumors were monomorphic and 48% polymorphic. The time to presentation defined the location and histology of disease. Of 17 patients diagnosed within 11 months of transplantation, PTLD involved the allograft in 12 (71%) and the GI tract in 1 ( p = 0.01). This “early” PTLD was 85% polymorphic ( p = 0.006). Conversely, of the 18 patients diagnosed more than 11 months after transplant, the lung was involved in 5 (28%) and the GI tract in 7 (39%; p = 0.01). “Late” PTLD was 71% monomorphic ( p = 0.006). Median overall survival after diagnosis was 18.57 months. Overall survival did not differ between all lung transplant recipients and those who developed PTLD. Conclusions PTLD is an uncommon complication after lung transplantation, and its incidence declined remarkably in the era of modern immunosuppression. We report several factors that are important for predisposition toward, progression of, and treatment of PTLD after lung transplantation.