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

doi:10.1016/j.healun.2020.06.010

The Journal of Heart and Lung Transplantation

Volume 39, Issue 10, October 2020, Pages 1089-1099

https://doi.org/10.1016/j.healun.2020.06.010 Get rights and content

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 <45 years or >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.

Section snippets

Study design

We analyzed the ISHLT Registry, an international longitudinal voluntary database that incorporates country and consortium transplant data reported by individual centers. A total of 260 lung transplant centers report to the ISHLT Registry, representing approximately 75% of the worldwide transplant activity.

Primary end-points and covariables

The primary end-point of interest was time to development of PTLD after lung transplantation. Outcomes were evaluated at time of yearly follow-up. Primary end-point was censored at last

Patient characteristics

ISHLT Registry data for 49,776 lung transplants performed between January 2006 and December 2016 were included. We excluded from analysis 3,852 LTRs with <1 year of follow-up, 1,392 LTRs receiving retransplantation, 21 LTRs receiving lobar lung transplant, 1,463 patients younger than 18 years of age, and 23,739 LTRs from centers not reporting PTLD during follow-up (Figure 1). Thus, the analysis cohort included 19,309 adult first LTRs.

Clinical characteristics of the study cohort are described in

Discussion

PTLD is a rare but life-threatening complication following transplantation. Several single-center analyses have identified numerous risk factors associated with PTLD such as primary EBV infection, organ transplanted, age, Caucasian race, and CMV mismatch.⁹^,19, 20, 21 However, these analyses are often limited by their small size. To our knowledge, for the first time with this study, we evaluated the incidence and identified pre- and peri-transplant clinical characteristics associated with PTLD

Disclosure statement

The authors have no conflict of interest to disclose.

This work was supported by the ISHLT Transplant Registry Early Career Award.

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ORIGINAL CLINICAL SCIENCEIncidence and outcome of post-transplant lymphoproliferative disorders in lung transplant patients: Analysis of ISHLT Registry

BACKGROUND

METHODS

RESULTS

CONCLUSIONS

Section snippets

Study design

Primary end-points and covariables

Patient characteristics

Discussion

Disclosure statement

J Heart Lung Transplant

Am J Transplant

J Cyst Fibros

Am J Transplant

J Heart Lung Transplant

Am J Transplant

Am J Transplant

Am J Transplant

J Heart Lung Transplant

Lancet

Chest

Am J Transplant

Am J Transplant

Post-transplant lymphoproliferative disease (PTLD): risk factors, diagnosis, and current treatment strategies

Curr Hematol Malig Rep

Posttransplant malignancies in solid organ adult recipients: an analysis of the U.S

National Transplant Database. Transplantation

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