BACKGROUND: Heart and lung transplant recipients have among of the highest incidence rates of post-transplant lymphoproliferative disease (PTLD). Despite this, there is a paucity of data specific to this group. We collated data on heart, lung and heart-lung transplant recipients with PTLD to identify disease features and prognostic factors unique to this group of patients. METHODS: Seventy cases of PTLD were identified from a single institution (41 heart, 22 lung, 6 heart-lung and 1 heart-kidney transplant) from 1984 to 2013. Demographics, immunosuppression, treatment, response, complications and survival data were analyzed. Uni- and multivariate Cox regression analyses were performed to identify prognostic factors. RESULTS: The incidence of PTLD was 7.59% in heart-lung, 5.37% in heart and 3.1% in lung transplant recipients. Extranodal disease (82%) with diffuse large B-cell lymphoma (72%) was the most common presentation. Bone marrow involvement (13%) and central nervous system disease (3%) were uncommon. Heart transplant recipients had later onset of PTLD (>1 year post-transplant), with less allograft involvement, compared with lung and heart-lung recipients. Poor prognostic markers were bone marrow involvement (HR 6.75, p < 0.001) and serum albumin <30 g/liter (HR 3.18, p = 0.006). Improved survival was seen with a complete response within 3 months of treatment (HR 0.08, p < 0.001). Five-year overall survival was 29%. CONCLUSION: This analysis is the largest to date on PTLD in heart and lung transplant recipients. It provides a detailed analysis of the disease in this group of patients and identifies unique prognostic features to aid risk stratification and guide treatment allocation.
BACKGROUND: Heart and lung transplant recipients have among of the highest incidence rates of post-transplant lymphoproliferative disease (PTLD). Despite this, there is a paucity of data specific to this group. We collated data on heart, lung and heart-lung transplant recipients with PTLD to identify disease features and prognostic factors unique to this group of patients. METHODS: Seventy cases of PTLD were identified from a single institution (41 heart, 22 lung, 6 heart-lung and 1 heart-kidney transplant) from 1984 to 2013. Demographics, immunosuppression, treatment, response, complications and survival data were analyzed. Uni- and multivariate Cox regression analyses were performed to identify prognostic factors. RESULTS: The incidence of PTLD was 7.59% in heart-lung, 5.37% in heart and 3.1% in lung transplant recipients. Extranodal disease (82%) with diffuse large B-cell lymphoma (72%) was the most common presentation. Bone marrow involvement (13%) and central nervous system disease (3%) were uncommon. Heart transplant recipients had later onset of PTLD (>1 year post-transplant), with less allograft involvement, compared with lung and heart-lung recipients. Poor prognostic markers were bone marrow involvement (HR 6.75, p < 0.001) and serum albumin <30 g/liter (HR 3.18, p = 0.006). Improved survival was seen with a complete response within 3 months of treatment (HR 0.08, p < 0.001). Five-year overall survival was 29%. CONCLUSION: This analysis is the largest to date on PTLD in heart and lung transplant recipients. It provides a detailed analysis of the disease in this group of patients and identifies unique prognostic features to aid risk stratification and guide treatment allocation.
Authors: Carlo J Iasella; Spencer A Winters; Abigail Kois; Jaehee Cho; Stefanie J Hannan; Ritchie Koshy; Cody A Moore; Christopher R Ensor; Elizabeth A Lendermon; Matthew R Morrell; Joseph M Pilewski; Pablo G Sanchez; Daniel J Kass; Jonathan K Alder; S Mehdi Nouraie; John F McDyer Journal: Am J Transplant Date: 2020-01-22 Impact factor: 8.086
Authors: Jesse Cheng; Cody A Moore; Carlo J Iasella; Allan R Glanville; Matthew R Morrell; Randall B Smith; John F McDyer; Christopher R Ensor Journal: Clin Transplant Date: 2018-03-30 Impact factor: 2.863
Authors: Christopher Felicelli; Nicolas Lopez-Hisijos; Reeba Omman; Daniel Shepherd; Vijayalakshmi Ananthanarayanan; Ameet R Kini; Rhett P Ketterling; Joseph J Maleszewski; Elaine S Jaffe; Sucha Nand; Joshua Newman; Ashish Haryani; Max Liebo; Kamran M Mirza Journal: J Heart Lung Transplant Date: 2020-07-07 Impact factor: 13.569
Authors: Harpreet Singh Grewal; Charles Lane; Kristin B Highland; Olufemi Akindipe; Marie Budev; Atul C Mehta Journal: Oxf Med Case Reports Date: 2018-03-07