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Posttransplant lymphoproliferative disorders in liver transplantation: a 20-year experience.

Jain, Ashok and Nalesnik, Mike and Reyes, Jorge and Pokharna, Renu and Mazariegos, George and Green, Michael and Eghtesad, Bijan and Marsh, Wallis and Cacciarelli, Thomas and Fontes, Paulo and Abu-Elmagd, Kareem and Sindhi, Rakesh and Demetris, Jake and Fung, John (2002) Posttransplant lymphoproliferative disorders in liver transplantation: a 20-year experience. Ann Surg, 236 (4). 429 - 436. ISSN 0003-4932

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Abstract

OBJECTIVE: To evaluate the incidence of posttransplant lymphoproliferative disease (PTLD) and the risk factors and the impact of this complication on survival outcomes in a large cohort of liver transplant recipients at a single institution. SUMMARY BACKGROUND DATA: Liver transplantation has been accepted as a therapeutic option for patients with end-stage liver disease since 1983, in large part due to the availability and reliance on the use of nonspecifically directed immunosuppression. However, as predicted and subsequently verified in 1968, an increased incidence of certain de novo malignancies has been observed, particularly with regards to lymphoid neoplasms. While many reports have confirmed and clarified the nature of PTLD, the literature is fraught with conflicting experience and outcomes with PTLD. METHODS: Four thousand consecutive patients who underwent liver transplants between February 1981 and April 1998 were included in this analysis and were followed to November 2001. The effect of recipient age at the time of transplant, recipient gender, diagnosis, baseline immunosuppression, grading of PTLD, and association with Epstein-Barr virus were compared. The causes of death were also examined. Treatment for PTLD varied over the 20-year period, but all included massive reduction or elimination of baseline immunosuppression. RESULTS: The 1-year patient survival for liver transplant patients with PTLD was 85%, while the overall patient survival for the entire cohort was 53%. The actuarial 20-year survival was estimated at 45%. The overall median time to PTLD presentation was 10 months, and children had an incidence of PTLD that was threefold higher than adults. Patient survival was better in children, in patients transplanted in the era of tacrolimus immunosuppression, in patients with polymorphic PTLD, and in those with limited disease. Interestingly, neither the presence or absence of Epstein-Barr virus nor the timing of PTLD presentation appeared to influence overall patient survival. Patients transplanted for alcohol-related liver disease had a similar incidence of PTLD but had a higher risk of mortality. CONCLUSIONS: While PTLD continues to pose problems in patients receiving liver transplants, improvements in patient survival have been observed over time. While it is too early to assess the impact of new advances in prophylaxis, diagnosis, and treatment, such approaches are based on an increased knowledge of the pathophysiology of PTLD.


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Details

Item Type: Article
Status: Published
Creators/Authors:
CreatorsEmailPitt UsernameORCID
Jain, Ashok
Nalesnik, Mike
Reyes, Jorge
Pokharna, Renu
Mazariegos, George
Green, Michael
Eghtesad, Bijan
Marsh, Wallis
Cacciarelli, Thomas
Fontes, Paulo
Abu-Elmagd, Kareem
Sindhi, Rakeshrsindhi@pitt.eduRSINDHI
Demetris, Jake
Fung, John
Centers: Other Centers, Institutes, or Units > Thomas E. Starzl Transplantation Institute
Date: October 2002
Date Type: Publication
Journal or Publication Title: Ann Surg
Volume: 236
Number: 4
Page Range: 429 - 436
DOI or Unique Handle: 10.1097/00000658-200210000-00005
Institution: University of Pittsburgh
Refereed: Yes
Uncontrolled Keywords: Adult, Age Factors, Child, Cohort Studies, Female, Follow-Up Studies, Humans, Incidence, Liver Transplantation, Lymphoproliferative Disorders, Male, Outcome Assessment (Health Care), Postoperative Complications, Retrospective Studies, Risk Factors, Severity of Illness Index, Survival Rate, Time Factors
ISSN: 0003-4932
Other ID: uls-drl:31735062120823, Starzl CV No. 2174
Date Deposited: 08 Apr 2010 17:37
Last Modified: 21 May 2019 14:55
URI: http://d-scholarship.pitt.edu/id/eprint/5560

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