Post-Transplant Lymphoproliferative Disorder in Liver Transplant Recipients: Characteristics, Management and Outcome from a Single-Centre Experience with >1000 Liver Transplantations

Abstract

This series from a single large-volume centre showed excellent short and long-term survival after PTLD in adult LTRs who were EBV negative, had early disease and showed complete response. Consistent with the known in vitro antiproliferative effect of sirolimus, switching IS from calcineurin inhibitor to sirolimus may improve survival.

Risk factors and clinical outcomes of pediatric liver transplant recipients with post‐transplant lymphoproliferative disease in a multi‐ethnic Asian cohort

“…We report a predominance of extranodal manifestations in our cohort, consistent with previous published literature: 8,35,36 we found that GI manifestations, in particular, appeared to be much more prevalent than in Western studies-81.3% (13/16) of diagnosed PTLD cases had some form of GI involvement, compared to previously published estimates at 10%-29%. 37,38 The prevalence of GI PTLD in other small…”

Post-transplant lymphoproliferative disease in liver transplant recipients

“…Risk factors for PTLD after liver transplant include EBV seronegativity, early age (especially children and adolescents), and high doses of immunosuppression and first year after transplant (11)(12)(13). In our case, 50% of recipients had EBV seronegativity prior to the liver transplant.…”

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

“…6,22,23 Although previously it has been reported that the majority of PTLD cases occur early posttransplant, within the first 1-2 years, more recent data suggest that late-onset PTLD is more common. 6,24 This is in keeping with our data in which 71% of cases occurred beyond 24 months. However, in contrast to other series in which PTLD occurring early is usually EBV positive, our series shows a similar distribution of EBV-positive PTLD in the early and late groups with the caveat that there are missing data.…”

“…In this study, we did not identify any impact of several clinical variables on response rates or OS including age, stage, early or late PTLD, EBV status and graft involvement. 6,24,26 This is possibly due to sample size. We included one patient in this study who was treated with single-agent rituximab for EBV reactivation alone with no clinical evidence of PTLD.…”

“…1,3 The majority of cases occur in the first year of transplant and the overall incidence of PTLD following liver transplantation is reported to be 1%-4% with a higher incidence seen in children. 2,[4][5][6] The risk of developing PTLD is variable and depends on the type of organ transplanted, the immunosuppression regimen, recipient age, time post-transplantation, ethnicity 2,7,8 and both patient and donor EBV status prior to transplant. 9 The degree of immunosuppression post-transplant has long been considered a major determinant of the development of PTLD, and the degree of T-cell suppression appears to be more important than the degree of overall immunosuppression.…”