Post‐transplant lymphoproliferative disorder in adult liver transplant recipients: a South American multicenter experience

Abstract

Post-transplant lymphoproliferative disorder (PTLD) is a major and potentially life-threatening complication after solid-organ transplantation. The aim of this study was to describe the disease characteristics, clinical practices, and survival related to PTLD in adult orthotopic liver transplant (OLT) recipients in South America. We conducted a survey at four different transplant groups from Argentina, Brazil, and Chile. Among 1621 OLT recipients, 27 developed PTLD (1.7%); the mean age at diagnosis was 53.7 (± 14) yr with a mean time of 39.7 (± 35.2) months from OLT to PTLD diagnosis. Initial therapy included reduction in immunosuppression alone in 23.1% of the patients. Either rituximab or chemotherapy was employed as initial or second-line therapy in 76.9% of the patients. PTLD location was frequently extranodal (80.7%) and mostly involving the transplanted liver (59.3%). The overall survival at one and five yr post-PTLD diagnosis was 53.8% and 46.2%, respectively. Significant univariate risk factors for post-PTLD mortality included lactate dehydrogenase ≥ 250 U/L (HR 9.66, p = 0.02), stage III/IV PTLD (HR 5.34, p = 0.004), and HCV infection (HR 7.68, p = 0.01). In conclusion, PTLD in OLT adult recipients is predominantly extranodal, and although mortality is high, long-term survival is possible.

Post-transplant lymphoproliferative disorders: From epidemiology to pathogenesis-driven treatment

“…A 1.3% of PTLD incidence was found by Ettorre et al [17] in a cohort of 1675 liver transplants from various Italian centers. Similarly, in an Argentinean cohort of 1621 liver transplant recipients, 27 patients developed PTLD (1.7%); early-onset disease was identified in 7 patients (27%) and late-onset in 19 (73%) [18], and yet another study reported a 2.3% (15/658) incidence of PTLD, of which 33% occurred during the first year after liver transplantation [19]. In a recent study of a total of 444 liver transplants, PTLD occurred in 16 (3.6%) patients, most being of early-onset (11/16, 69%) [20].…”

Post-transplant lymphoproliferative disease in liver transplant recipients

“…Rituximab therapy (an antibody against the CD20 receptor of B cells) seems to be effective in the management of PTLD cases, with a remission rate of 45-65% (17,26). In our study, 30% of patients received rituximab as first-line treatment, with a complete remission observed in 66% of these cases.…”

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“…1,2 In orthotopic liver transplant recipients, the reported incidence ranges from 1.7% to 11.1% with incidence being greater in children (9.7%–11%) and lesser in adults (1%–3%). 3–6 Approximately 60% to 85% of cases of PTLD are associated with Epstein-Barr virus infection. 5,6 Estimates of 1-year survival after PTLD in all graft types range from 56% to 73%, with 5-year estimates falling between 40% to 61%.…”

“…3–6 Approximately 60% to 85% of cases of PTLD are associated with Epstein-Barr virus infection. 5,6 Estimates of 1-year survival after PTLD in all graft types range from 56% to 73%, with 5-year estimates falling between 40% to 61%. 1 The reported 1-, 5- and 10-year survival rates for posttransplant PTLD in liver recipients are 53.8% to 85%, 46.2% to 69%, and 55%.…”

“…1 The reported 1-, 5- and 10-year survival rates for posttransplant PTLD in liver recipients are 53.8% to 85%, 46.2% to 69%, and 55%. 5,6 …”