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

Kremers, Walter K.; Devarbhavi, Harshad; Wiesner, Russell H.; Krom, R. A. F.; Macon, William R.; Habermann, Thomas M.

doi:10.1111/j.1600-6143.2006.01294.x

Cited by 133 publications

(79 citation statements)

References 41 publications

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“…In our cohort a slightly higher PTLD rate (2.9%) than in the literature (1-2%) was detected (45). The rate of skin squamous cell carcinomas in our cohort is in line with rates reported in the literature, showing nonmelanoma skin cancers to be the most common de novo malignancies after LT (46).…”

Section: Twenty-year Survival After Liver Transplantationsupporting

confidence: 89%

Twenty-Year Longitudinal Follow-Up After Orthotopic Liver Transplantation: A Single-Center Experience of 313 Consecutive Cases

Schoening

Buescher

Rademacher

et al. 2013

American Journal of Transplantation

107

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y These authors have contributed equally to this work.With excellent short-term survival in liver transplantation (LT), we now focus on long-term outcome and report the first European single-center 20-year survival data. Three hundred thirty-seven LT were performed in 313 patients (09/88-12/92). Impact on long-term outcome was studied and a comparison to life expectancy of matched normal population was performed. A detailed analysis of 20-years follow-up concerning overweight (HBMI), hypertension (HTN), diabetes (HGL), hyperlipidemia (HLIP) and moderately or severely impaired renal function (MIRF, SIRF) is presented. Patient and graft survival at 1, 10, 20 years were 88.4%, 72.7%, 52.5% and 83.7%, 64.7% and 46.6%, respectively. Excluding 1-year mortality, survival in the elderly LT recipients was similar to normal population. Primary indication (p < 0.001), age (p < 0.001), gender (p ¼ 0.017), impaired renal function at 6 months (p < 0.001) and retransplantation (p ¼ 0.034) had significant impact on patient survival. Recurrent disease (21.3%), infection (20.6%) and de novo malignancy (19.9%) were the most common causes of death. Prevalence of .2%, p < 0.001), p ¼ 0.01) and HBMI (33.2-45%, p ¼ 0.014) increased throughout follow-up, while prevalence of HLIP (78.0-47.6%, p < 0.001) declined. LT has conquered many barriers to achieve these outstanding long-term results. However, much work is needed to combat recurrent disease and side effects of immunosuppression (IS).

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Section: Twenty-year Survival After Liver Transplantationsupporting

confidence: 89%

Twenty-Year Longitudinal Follow-Up After Orthotopic Liver Transplantation: A Single-Center Experience of 313 Consecutive Cases

Schoening

Buescher

Rademacher

et al. 2013

American Journal of Transplantation

107

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“…PTLD represents a spectrum of tumors ranging from benign lymphoid proliferation to malignant monomorphic ß-cell lymphoma that is associated with high mortality (13)(14)(15)(16) (1,6,17). (19)(20)(21)(22).…”

Section: Pancreas Transplantation Is a Successful Treatment For Diabementioning

confidence: 99%

Posttransplant Lymphoproliferative Disorder Following Pancreas Transplantation

Issa

Amer

Dean³

et al. 2009

American Journal of Transplantation

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The incidence, risk factors and impact on patient and graft survival were evaluated for posttransplant lymphoproliferative disorder (PTLD) among 212 pancreas transplant recipients. Thirteen (6.1%) developed PTLD during 71 ± 27 months follow-up. Cumulative incidences of PTLD at 1, 3, 5 and 10 years posttransplant were 4.2%, 5.3%, 6.0% and 7.0%, respectively. Incidence of PTLD was lower for recipients of simultaneous pancreas kidney compared to pancreas after kidney transplant or pancreas transplant alone, though not significantly so. Recipient Epstein-Barr virus (EBV) seronegativity and number of doses of depleting antibody therapy administered at transplant were associated with increased risk of PTLD, while recipient age, gender, transplant type, cytomegalovirus mismatch maintenance immunosuppression type and treated acute rejection were not. All 13 cases underwent immunosuppression reduction, and 10 received anti-CD20 monoclonal antibody. During follow-up, 10/13 (77%) responded to treatment with complete remission, while 3 (23%) died as a result of PTLD. Patient and graft survivals did not differ for recipients with and without PTLD. The strong association of PTLD with EBV-seronegativity requires considering this risk factor when evaluating and monitoring pancreas transplant recipients. With reduction of immunosuppression and anti-CD20 therapy, survival for pancreas transplant recipients with PTLD was substantially better than previously reported.

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“…118 The association of PTLD with EBV infection is variable in adult LT recipients; later onset PTLD is less likely to be EBV-associated. 119,120 PTLD include lymphadenopathy, cytopenias, unexplained fever, and disturbances of the gastrointestinal tract, lungs, spleen, and central nervous system.…”

Section: Epstein-barr Virusmentioning

confidence: 99%

Infections After Orthotopic Liver Transplantation

Pedersen

Seetharam

2014

Journal of Clinical and Experimental Hepatology

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Opportunistic infections are a leading cause of morbidity and mortality after orthotopic liver transplantation. Systemic immunosuppression renders the liver recipient susceptible to de novo infection with bacteria, viruses and fungi post-transplantation as well to reactivation of pre-existing, latent disease. Pathogens are also transmissible via the donor organ. The time from transplantation and degree of immunosuppression may guide the differential diagnosis of potential infectious agents. However, typical systemic signs and symptoms of infection are often absent or blunted after transplant and a high index of suspicion is needed. Invasive procedures are often required to procure tissue for culture and guide antimicrobial therapy. Antimicrobial prophylaxis reduces the incidence of opportunistic infections and is routinely employed in the care of patients after liver transplant. In this review, we survey common bacterial, fungal, and viral infections after orthotopic liver transplantation and highlight recent developments in their diagnosis and management. ( J CLIN EXP HEPATOL 2014;4:347-360) I nfection after orthotopic liver transplantation (OLT) is a major cause of morbidity and mortality. Infection is estimated to occur in upto 80% of organ recipients. Bacterial infections are most frequent (70%), followed by viral (20%) and fungal infections (8%). 1,2,3 In addition to direct effects of infection and end-organ inflammation, pathogens may have a number of indirect effects that result in allograft injury, rejection and opportunistic superinfection.The risk of infection in liver transplant recipients is determined by the intensity of exposure to infectious agents and the overall level of immunosuppression. 4 In addition, conditions attendant to end-stage liver disease in the immediate perioperative period may render a recipient vulnerable to infection and include: neutropenia, deficits in mucocutaneous barrier integrity, presence of necrotic tissue, ischemia, diabetes mellitus, immunomodulating viruses, uremia, and protein-calorie malnutrition. 5 Infectious exposures come from many sources post liver transplant including: de novo (acquired acute) in the recipient, reactivation in the recipient, the donor organ, and nosocomial and time from transplant may provide clues to etiology (Figure 1). The overall level of immunosuppression is dependent upon the dose, duration, and choice of immunosuppression as well as underlying immune deficiencies. 6 Inflammatory responses to invading pathogens are often blunted by immunosuppressive therapy, and as a result, the classic signs or symptoms of infection may be absent. A high index of suspicion is need in the liver recipient, and a low threshold to perform invasive diagnostic procedures is often required. It is critical to identify clinical factors that predispose recipients to infection and much interest centers on identifying risk factors for infection after liver transplant. GENETIC POLYMORPHISMS IN THE INNATE IMMUNE SYSTEMIn addition to clinical factors that promote ...

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

Cited by 133 publications

References 41 publications

Twenty-Year Longitudinal Follow-Up After Orthotopic Liver Transplantation: A Single-Center Experience of 313 Consecutive Cases

Twenty-Year Longitudinal Follow-Up After Orthotopic Liver Transplantation: A Single-Center Experience of 313 Consecutive Cases

Posttransplant Lymphoproliferative Disorder Following Pancreas Transplantation

Infections After Orthotopic Liver Transplantation

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