Posttransplant Lymphoproliferative Disorder After Liver and Kidney Transplant

Abstract

Objectives: We evaluated posttransplant lymphoproliferative disorder after solid-organ transplant.

Materials and Methods: All 2224 solid-organ transplant recipients who underwent transplant between 1985 and 2013 were included. Clinicopathological findings were examined, and all patients with posttransplant lymphoproliferative disorder were reclassified to World Health Organization 2008 lymphoma classification.

Results: Only 27 of 2224 patients developed posttransplant lymphoproliferative disorder. The incidence of posttransplant lymphoproliferative disorder was 3.3-fold higher in children than in adults. The mean interval between transplant and diagnosis of posttransplant lymphoproliferative disorder was 65 months. Patients with tacrolimus were associated with a shorter posttransplant lymphoproliferative disorder development time compared with cyclosporine patients. Epstein-Barr virus-encoded small RNA positive showed shorter time for development of posttransplant lymphoproliferative disorder compared with EpsteinBarr virus-encoded small RNA negative patients. The risk of developing posttransplant lymphoproliferative disorder within the first year of transplant was higher in patients under tacrolimus protocol compared with patients under cyclosporine. Of 27 patients, 4 showed early lesion and 23 patients showed monomorphic posttransplant lymphoproliferative disorder. The development of T-cell monomorphic posttransplant lymphoproliferative disorder was significantly late compared with patients with B-cell monomorphic posttransplant lymphoproliferative disorder. Eight patients died at 38 50 months after posttransplant lymphoproliferative disorder diagnosis. Four patients with early type posttransplant lymphoproliferative disorder were alive, and 3 of 4 patients with T-cell monomorphic posttransplant lymphoproliferative disorder died shortly after diagnosis. Five of 19 patients with B-cell monomorphic posttransplant lymphoproliferative disorder died at a mean 29 18 months. A significant difference was found between the histologic types regarding patient survival. A significant difference was found between the Epstein-Barr virus-encoded small RNA positive and Epstein-Barr virus-encoded small RNA negative patients regarding mean survival time.

Conclusions: To decrease the incidence of posttransplant lymphoproliferative disorder, risk factors should be evaluated and new approaches must be derived for prophylaxis, diagnosis, and treatment.