A retrospective analysis of post‐transplant lymphoproliferative disorder following liver transplantation

Abstract

Objective: To evaluate response rates and survival in adults developing post-transplant lymphoproliferative disorder (PTLD) following liver transplantation. Methods:Patients were identified retrospectively and data collected through local liver and haematology electronic databases and pharmacy records.Results: Forty-five patients were identified. The median age at first transplant and at development of PTLD was 48 and 54 years, respectively, with the median time from transplant to PTLD diagnosis of 56 months. The majority of cases (76%) were monomorphic B-cell lymphomas, and 36% of tumours were EBV positive. Treatment involved reduction in immune-suppression (RIS) in 30 (67%) with RIS the only treatment in 3. Ten (22%) patients were treated with rituximab alone, 13 (29%) with chemotherapy alone and 14 (31%) patients were treated with rituximab and chemotherapy.Twenty-six (58%) patients achieved a complete response (CR). At a median follow-up of 27 months, the median overall survival (OS) was 50 months. Response and OS were not associated with clinical factors or the use of rituximab. Conclusion:Outcomes reported in this study are favourable and comparable to those reported previously. The addition of rituximab did not appear to have improved outcomes in this series, although a significant proportion of patients were able to avoid chemotherapy. K E Y W O R D Sliver transplant, non-Hodgkin lymphoma, PTLD, Rituximab

Posttransplant Lymphoproliferative Disorder Isolated to the Adrenal Gland in a Liver Transplant Patient

“… 8 Risk factors include younger age, use of antibodies for immunosuppression induction, and amount of donor lymphoid tissue transplanted. 10 …”

“…Immune suppression reduction is the first step in treatment. 10 , 12 The specifics of immune-suppression reduction are individualized based on the transplanted organ, the extent of PTLD, and the risk of graft rejection. European and American guidelines recommend discontinuation or dose reduction of antiproliferative agents such as mycophenolate and azathioprine in limited disease.…”

Pediatric Liver Transplantation: Long-Term Follow-Up Issues

“…63 The pathogenesis is multifactorial: impaired immune surveillance of tumor cells due to immunosuppression decreases antiviral immune activity, oncogenic effect of EBV, and derangement of molecular signaling/DNA repair mechanisms by direct effects of immunosuppressive agents. 65 1. Diagnosis: CMV pp65 antigenemia 2.…”

Early‐ and late‐onset posttransplant lymphoproliferative disorders among adult kidney and liver transplant recipients

“…Solid organ transplant (SOT) recipients have an increased risk of infections and malignancies due to the immunosuppression they receive in order to prevent allograft rejection 1 . A well‐known malignancy in SOT recipients is posttransplant lymphoproliferative disorder (PTLD), 2,3 which encompasses a broad spectrum of clinico‐pathological presentations, ranging from benign neoplasms to disseminating monoclonal malignancies 4–6 …”