Post-transplant lymphoproliferative disease in heart and lung transplantation: Defining risk and prognostic factors

Kumarasinghe, G.; Lavee, Orly; Parker, Andrew; Nivison-Smith, Ian; Milliken, Samuel; Dodds, Anthony J.; Joseph, Joanne; Fay, Keith; David, D. F.; Malouf, M.A.; Plit, M.; Havryk, A.; Keogh, A.; Hayward, Christopher; Kotlyar, Eugene; Jabbour, Andrew; Glanville, Allan R.; Macdonald, P.; Moore, John J.

doi:10.1016/j.healun.2015.05.021

Cited by 58 publications

(45 citation statements)

References 44 publications

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“…The several studies that we analyzed here have attempted to identify patient demographics, risk factors, disease characteristics, and treatments to tailor strategies for the treatment and management of PTLD, but none have established definitive conclusions for better outcomes. Kumarasinghe et al in 2010 published their findings at 1 single center for heart and lung transplantation that identified overall survival prognostic factors of bone marrow involvement (HR 6.75, P < .001), hypoalbuminemia (HR 3.18, P = .006), and complete response within 1‐3 months (HR 0.08, P < .001) . The ISHLT has also reported that patients who receive bilateral lung transplants tend to be younger (<65) and are less subjected to comorbidities and post‐transplant complications, since releasing registry reports in 1998 .…”

Section: Discussionmentioning

confidence: 99%

Systematic review and meta‐analysis of post‐transplant lymphoproliferative disorder in lung transplant recipients

Cheng

Moore

Iasella

et al. 2018

Clinical Transplantation

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A systematic review of papers in English on post-transplant lymphoproliferative disorder (PTLD) in lung transplant recipients (LTR) using MEDLINE, EMBASE, SCOPUS, and Cochrane databases was performed. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations were strictly adhered to. Pooled odds ratios (pOR) were calculated from a random-effects model, and heterogeneity among studies was quantitated using I values. Fourteen studies published from 2005 to 2015 were included in the meta-analysis. One hundred and sixty-four lung transplant recipients were included. LTRs who received single vs bilateral were associated with a 7.67-fold risk of death after PTLD (6 studies with 64 LTRs; pOR 7.67 95% CI 1.98-29.70; P = .003). pOR of death for early onset PTLD (<1 year post-LT) vs late onset (>1 year post-LT) was not different (3 studies with 72 LTRS; pOR 0.62, 95% CI 0.20-1.86, P = .39). Standardized mean difference (SMD) in time from transplant to PTLD onset between LTRs who died vs alive was not different (9 studies with 109 LTRs; SMD 0.03, 95% CI -0.48-0.53, P = .92). Survival in polymorphic vs monomorphic PTLD and extranodal vs nodal disease was similar (4 studies with 31 LTRs; pOR 0.44, 95% CI 0.08-2.51; P = .36. 6 studies with 81 LTRs; pOR 1.05 95% CI 0.31-3.52, P = .94). This meta-analysis demonstrates that single LTRs are at a higher risk of death vs bilateral LTRs after the development of PTLD.

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Section: Discussionmentioning

confidence: 99%

Systematic review and meta‐analysis of post‐transplant lymphoproliferative disorder in lung transplant recipients

Cheng

Moore

Iasella

et al. 2018

Clinical Transplantation

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“…The incidence of PTLD also varies with the type of transplanted organ. LT recipients are less likely to develop PTLD as compared to intestinal (19%), lung (8%), or heart (3%) transplant recipients, but more likely than the kidney transplant recipients (<1%) . A clear explanation on the differences in incidence is yet to be defined but may relate to the function of immune cells in each transplanted organ.…”

Section: Discussionmentioning

confidence: 99%

Various initial presentations of Epstein‐Barr virus infection‐associated post‐transplant lymphoproliferative disorder in pediatric liver transplantation recipients: Case series and literature review

Simakachorn

Tanpowpong

Lertudomphonwanit

et al. 2019

Pediatric Transplantation

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PTLD is a rare but potentially life‐threatening condition, which shows a higher prevalence in children than in adults. From 129 children who underwent LT, we reported 5 cases with biopsy‐proven PTLD at a single teaching hospital. Four patients had shared clinical presentations including fever, lymphadenopathy, and splenomegaly. They were noted to be given a prolonged course of IS due to the management of comorbid complications such as acute cellular rejection or severe food allergy or eosinophilic gastrointestinal disease. The other one patient presented with upper gastrointestinal bleeding from gastric mass during an early post‐transplantation period. Notably, hypoalbuminemia was noted in all reported patients. Similar to previous studies, both EBV serology mismatch between the donor and recipient with high EBV viral load were noted in all except one case, whose EBV serology was unknown before LT. At least one episode of CMV reactivation was also observed in 3 of 5 patients prior to the PTLD diagnosis. The histopathology revealed 1 of 5 early PTLD, 1 of 5 polymorphic PTLD, and 3 of 5 monomorphic PTLD. The treatment included IS withdrawal, chemotherapy, and/or rituximab. One patient died of multiorgan dysfunction, one remains in complete remission, and three patients are either still on treatment or await response evaluation. Even though most of our reported PTLD cases had shared manifestations with fever, lymphadenopathy, splenomegaly, EBV serology mismatch, and high EBV viral load, various initial presentations such as respiratory symptoms, hypoalbuminemia, and prolonged use of IS from other causes such as significant food allergy were noted.

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“…The incidence of PTLD in the cardiac transplant recipients has previously been reported between 3%–9% 55. It can regress if immunosuppression is significantly reduced, but chemotherapy is required in many cases.…”

Section: Discussionmentioning

confidence: 99%

Cardiac transplantation: indications, eligibility and current outcomes

Bhagra

Pettit

Parameshwar

2018

Heart

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Post-transplant lymphoproliferative disease in heart and lung transplantation: Defining risk and prognostic factors

Abstract: This analysis is the largest to date on PTLD in heart and lung transplant recipients. It provides a detailed analysis of the disease in this group of patients and identifies unique prognostic features to aid risk stratification and guide treatment allocation.

Cited by 58 publications

References 44 publications

Systematic review and meta‐analysis of post‐transplant lymphoproliferative disorder in lung transplant recipients

Systematic review and meta‐analysis of post‐transplant lymphoproliferative disorder in lung transplant recipients

Various initial presentations of Epstein‐Barr virus infection‐associated post‐transplant lymphoproliferative disorder in pediatric liver transplantation recipients: Case series and literature review

Cardiac transplantation: indications, eligibility and current outcomes

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