Increased Risk for Posttransplant Lymphoproliferative Disease in Recipients of Liver Transplants With Hepatitis C

McLaughlin, Kevin; Wajstaub, S; Marotta, Paul; Adams, Paul C.; Grant, David; Wall, William; Jevnikar, Anthony M.; Rizkalla, Kamilla S.

doi:10.1053/jlts.2000.7578

Cited by 74 publications

(46 citation statements)

References 18 publications

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“…These are viewed as distinct from the EBV positive PTLD because they tend to occur later after transplantation and have a worse prognosis (16)(17)(18)(19)(20). Studies are conflicting regarding the potential role of hepatitis C virus, alcoholic cirrhosis and older age as risk factors for PTLD (21)(22)(23)(24)(25). Therefore, besides immunosuppression and EBV, relatively little is known about the pre-transplant clinical factors associated with the risk of PTLD.…”

Section: Introductionmentioning

confidence: 99%

Post-Transplant Lymphoproliferative Disorders Following Liver Transplantation: Incidence, Risk Factors and Survival

Kremers¹,

Devarbhavi²,

Wiesner³

et al. 2006

American Journal of Transplantation

133

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This study investigates retrospectively the incidence, risk factors and mortality of post-transplant lymphoproliferative disorders (PTLD) in adult orthotopic liver transplant (OLT) recipients. Among 1206 OLT recipients at a single institution, 37 developed a PTLD. The incidence of PTLD was highest during the first 18 months and relatively constant thereafter with cumulative incidence of 1.1% at 18 months and 4.7% at 15 years. The risk of PTLD was approximately 10% to 15% of the risk of death without PTLD. During the first 4 years following OLT, PTLD were predominantly related to EBV, while afterward most PTLD were EBV negative. Significant risk factors for PTLD in OLT recipients were transplantation for acute fulminant hepatitis during the first 18 months following OLT (HR = 2.6, p = 0.007), and rejection therapy with high-dose steroids (HR = 4.5, p = 0.049) and OKT3 (HR = 3.9, p = 0.016) during the previous year. Therapy with high-dose steroids or OKT3 (HR = 3.6, p = 0.0071) were also significant risk factors for PTLD-associated mortality. OLT recipients remain at risk for PTLD years after transplantation. The strong association of PTLD with rejection therapy and the worse post-PTLD prognosis among recipients of rejection therapy indicate the need to balance the risk of immunosuppression against the risk of PTLD following rejection treatment.

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Section: Introductionmentioning

confidence: 99%

Post-Transplant Lymphoproliferative Disorders Following Liver Transplantation: Incidence, Risk Factors and Survival

Kremers¹,

Devarbhavi²,

Wiesner³

et al. 2006

American Journal of Transplantation

133

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“…Other risk factors that have been associated with PTLD are HCV recurrence on the graft, age older than 50 years, alcoholic cirrhosis and hepatitis C cirrhosis (16). In our series, all patients were of legal age, with an average age of presentation of 50 years (range 20-67 years).…”

Section: Risk Factors For Ptld Developmentmentioning

confidence: 72%

Post-transplant lymphoproliferative disease in liver transplant recipients

et al. 2017

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Introduction: Post-transplant lymphoproliferative syndrome (PTLD) is a rare and potentially life-threatening complication after liver transplantation. The aim of this study was to analyze the clinicopathologic features related to PTLD in a single institution after liver transplantation.Methods: Observational study where we have retrospectively analyzed 851 cases who underwent liver transplantation. Ten cases have developed PTLD. Their clinical-pathological characteristics and the treatment received have been analyzed.Results: PTLD incidence was 1.2% (10/851). The mean time from liver transplantation to PTLD diagnosis was 36 months (range 1.2 to 144 months). PTLD localization was extranodal in all cases, the most frequent location being intestinal. Seven cases showed a monomorphic lymphoma which in all cases was differentiated B cell lymphomas. Fifty per cent of the series were seropositive for Epstein-Barr virus. Five patients were alive at the time of the review. Among these patients, we observed three cases of complete remission and two cases of disease stabilization. The death rate was higher in the first year after diagnosis of PTLD.Conclusion: PTLD is a rare complication after liver transplantation, but it may pose a threat to the life of a liver transplant recipient. It is essential to identify patients at risk, to establish an early diagnosis and treatment that can change the outcome of the disease.

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“…Morton and colleagues [29] in a retrospective cohort study of all individuals in the United States who received their first solid organ transplant from 1994 to 2005 using Scientific Registry of Transplant Recipients data reported that 1,630 patients were diagnosed with PTLD and HCV prevalence at transplantation was 11.3%; they concluded that HCV infection did not increase PTLD risk in the total cohort. McLaughlin et al [30] reported an increased risk for PTLD in HCV liver transplants recipients (7%) versus HCV negative recipients (0.8%, p=0.02). In our experience all patients diagnosed with de novo post-transplant lymphoproliferative disease were HCV or HBV positive confirming a role of viral infection in PTLD development.…”

Section: Page 5 Ofmentioning

confidence: 97%