Post‐transplant lymphoproliferative disorders in lung transplant recipients: 20‐yr experience at the University of Minnesota

Abstract

Post-transplant lymphoproliferative disorders (PTLD) are potentially fatal complications of solid organ transplantation. The natural history of PTLD varies considerably among the different types of organs transplanted. While lung transplant recipients are highly susceptible to PTLD, there are only a few small studies that detail PTLD in this setting. We undertook this study to better describe the characteristics and treatment response in PTLD after lung transplantation. We conducted a retrospective chart review of lung and heart/lung-transplant recipients between 1985 and 2008. A total of 32 cases (5%) of PTLD were identified in 639 patients. The median interval after transplantation to the diagnosis was 40 (3-242) months. Eight patients (25%) were diagnosed within one yr of transplantation and had PTLD predominantly within the thorax and allograft. Twenty-four patients (75%) were diagnosed more than one yr after transplantation and their tumors mainly affected the gastrointestinal tract. Monomorphic PTLD, diffuse large B-cell lymphoma, was diagnosed in 91%. Treatment of PTLD varied according to stage and clinical circumstances. Twenty-four patients (75%) have died. The median overall survival was 10 (0-108) months. PTLD after lung transplantation remains a challenge as a result of its frequency, complexity and disappointing outcome.

Lymphoproliferative Disorders after Lung Transplantation: Clinicopathological Characterization of 16 Cases with Identification of Very-Late-Onset Forms

“…We confirm the low incidence of PTLD in our experience, but in recent years, we have also encountered some late-occurring cases. Several series have shown that such PTLD cases occurring late after transplantation (usually after 1 year) were different from early cases [4,5,7,11]. Indeed, in our series, the 5 cases occurring more than 4 years after transplantation contrasted with the 11 cases occurring less than 18 months after transplantation.…”

“…These rare lesions are called posttransplant lymphoproliferative disorders (PTLD), and most are Epstein-Barr virus (EBV) related. PTLD in the setting of lung transplantation has some specificities: a higher incidence as compared with transplantation of most other organs [1,3], a frequent involvement of the grafted lung [3,4,5,6], and the risk of dysfunction or loss of a vital graft if immunosuppression is importantly reduced [4,7]. PTLD mostly occur in the first posttransplant year [8], but late cases have been increasingly reported in lung transplant recipients [4,5,7].…”

Targeting the PI3K/AKT/mTOR Signaling Axis in Children with Hematologic Malignancies

“…The vast majority of these LPDs occur as a consequence of Epstein-Barr virus (EBV) infection after solid organ transplant or HSCT, and are appropriately named posttransplant lymphoproliferative disorders (PTLDs). [204,205] Children can also develop viralLPDs with inherited immune deficiencies, including, but not limited to, ataxia telangiectasia, Wiscott-Aldrich syndrome, severe combined immune deficiency, and common variable immunodeficiency. [206,207] PTLDs and other viral-LPDs have the potential for malignant transformation and can be life threatening.…”

Epstein-Barr virus-associated post-transplantation lymphoproliferative disorder as a complication after cadaveric lung transplantation following allogeneic hematopoietic stem cell transplantation

“…Generally, immunosuppression post lung transplantation consists of a higher degree of immunosuppression than that used for other organs, therefore a higher incidence of PTLD is seen in lung transplant recipients. [4][5][6] PTLD in solid organ transplantation is almost always identified in recipients. When it is identified, it most often occurs within the first year after transplantation, although PTLD after allo-HSCT is predominantly derived from donor B cells and typically occurs within the first 6 months after allo-HSCT.…”

“…4,5 To date, however, HHV6-associated pleurisy has not been recognized as a complication of HSCT. In this report, we describe an adult HSCT recipient who developed HHV6-associated pleurisy after an unrelated cord blood transplantation (CBT).…”