Incidence and outcome of post-transplant lymphoproliferative disorders in lung transplant patients: Analysis of ISHLT Registry

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Publisher: Elsevier B.V.
Document Type: Report
Length: 385 words

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KEYWORDS lung transplant; PTLD; malignancy; Epstein-Barr virus; age; induction BACKGROUND Post-transplant lymphoproliferative disorder (PTLD) is a life-threatening complication following lung transplant. We studied incidence and risk factors for PTLD in adult lung transplant recipients (LTRs) using the International Society for Heart and Lung Transplantation Registry. METHODS The International Society for Heart and Lung Transplantation Registry was used to identify adult, first-time, single and bilateral LTRs with at least 1 year of follow-up between 2006 and 2016. Kaplan--Meier method was used to describe the timing and distribution of PTLD. Univariable and multivariable Cox proportional hazards regression models were used to examine clinical characteristics associated with PTLD. RESULTS Of 19,309 LTRs in the analysis cohort, we identified 454 cases of PTLD. Cumulative incidence of PTLD was 1.1% (95% CI = 1.0%--1.3%) at 1 year and 4.1% (95% CI = 3.6%--4.6%) at 10 years. Of the PTLD cases, 47.4% occurred within the first year following lung transplantation. In the multivariable model, independent risk factors for PTLD included age, Epstein--Barr virus serostatus, restrictive lung diseases, and induction. Risk of PTLD during the first year after transplant increased with increasing age in patients between 45 and 62 years at time of transplantation; the inverse was true for ages 62 years. Finally, receiving a donor organ with human leukocyte antigen types A1 and A24 was associated with an increased risk of PTLD, whereas the recipient human leukocyte antigen type DR11 was associated with a decreased risk. CONCLUSIONS Our study indicates that PTLD is a relatively rare complication among adult LTRs. We identified clinical characteristics that are associated with an increased risk of PTLD. Author Affiliation: (a) Division of Pulmonary, Allergy and Critical Care, Duke University Medical Center, Durham, North Carolina (b) Duke Clinical Research Institute, Durham, North Carolina (c) Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina (d) United Network for Organ Sharing, Richmond, Virginia (e) School of Medicine, The University of Queensland, Brisbane, Australia * Reprint requests: Lorenzo Zaffiri, MD, PhD, Division of Pulmonary, Allergy and Critical Care, Duke University, 2075 Medical Science Research Building II, 2 Genome Court, Durham, NC 27710. Telephone: 919-684-7989. Fax: 919-684-5266. Byline: Lorenzo Zaffiri, MD, PhD [lorenzo.zaffiri@duke.edu] (a,*), Alex Long, MS (a,b), Megan L. Neely, PhD (c), Wida S. Cherikh, PhD (d), Daniel C. Chambers, MD, FRACP (e), Laurie D. Snyder, MD (a)

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Gale Document Number: GALE|A640050805