Erin M Lowery1, William Adams2, Shellee A Grim3, Nina M Clark3, Leah Edwards4, Jennifer E Layden5. 1. Department of Internal Medicine at Loyola University Medical Center, Maywood, IL, United States; Health Sciences Division, Loyola University Chicago, Maywood, IL, United States. Electronic address: elowery@lumc.edu. 2. Health Sciences Division, Loyola University Chicago, Maywood, IL, United States. 3. Department of Internal Medicine at Loyola University Medical Center, Maywood, IL, United States. 4. United Network for Organ Sharing, United States. 5. Department of Internal Medicine at Loyola University Medical Center, Maywood, IL, United States; Health Sciences Division, Loyola University Chicago, Maywood, IL, United States.
Abstract
BACKGROUND: Post-transplant lymphoproliferative disease (PTLD) is an important cause of morbidity and mortality following lung transplantation. Recipients with cystic fibrosis (CF) may have an increased risk of PTLD although the literature is limited to single center cohorts. Our primary aim is to examine PTLD in an adult lung transplant population by utilizing the International Society for Heart and Lung Transplantation Registry. METHODS: We studied 30,598 adult recipients of lung transplants performed between 1999 and 2011. The primary outcome was development of and time to PTLD. In addition to indication for transplant, other predictors examined included Epstein-Barr virus (EBV) and cytomegalovirus (CMV) serostatus, gender, and age. Outcomes were assessed with univariable and multivariable Cox proportional hazard models to obtain hazard ratios (HR). RESULTS: 17% of the cohort had a diagnosis of CF. PTLD developed in 2% of CF recipients compared to 1% for non-CF recipients (p<0.001). Compared to non-CF recipients, CF recipients had higher prevalence of EBV and CMV seronegativity and higher prevalences of high risk EBV and CMV mismatch (D+/R-). There is a significant association between CF and the development of PTLD [HR 1.66 (95% CI 1.30-2.12)]. Stratified multivariable analysis controlling for age revealed EBV negative non-CF recipients have an almost 2 fold increased risk of developing PTLD, whereas EBV negative CF recipients had an almost 6.5 fold increased risk. CONCLUSIONS: CF recipients have a higher risk for PTLD compared to non-CF recipients. Further studies are needed to account for additional risk factors and management in this population post-transplant.
BACKGROUND: Post-transplant lymphoproliferative disease (PTLD) is an important cause of morbidity and mortality following lung transplantation. Recipients with cystic fibrosis (CF) may have an increased risk of PTLD although the literature is limited to single center cohorts. Our primary aim is to examine PTLD in an adult lung transplant population by utilizing the International Society for Heart and Lung Transplantation Registry. METHODS: We studied 30,598 adult recipients of lung transplants performed between 1999 and 2011. The primary outcome was development of and time to PTLD. In addition to indication for transplant, other predictors examined included Epstein-Barr virus (EBV) and cytomegalovirus (CMV) serostatus, gender, and age. Outcomes were assessed with univariable and multivariable Cox proportional hazard models to obtain hazard ratios (HR). RESULTS: 17% of the cohort had a diagnosis of CF. PTLD developed in 2% of CF recipients compared to 1% for non-CF recipients (p<0.001). Compared to non-CF recipients, CF recipients had higher prevalence of EBV and CMV seronegativity and higher prevalences of high risk EBV and CMV mismatch (D+/R-). There is a significant association between CF and the development of PTLD [HR 1.66 (95% CI 1.30-2.12)]. Stratified multivariable analysis controlling for age revealed EBV negative non-CF recipients have an almost 2 fold increased risk of developing PTLD, whereas EBV negative CF recipients had an almost 6.5 fold increased risk. CONCLUSIONS: CF recipients have a higher risk for PTLD compared to non-CF recipients. Further studies are needed to account for additional risk factors and management in this population post-transplant.
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: Lorenzo Zaffiri; Alex Long; Megan L Neely; Wida S Cherikh; Daniel C Chambers; Laurie D Snyder Journal: J Heart Lung Transplant Date: 2020-06-20 Impact factor: 10.247