Heart Allograft Involvement by Posttransplant Lymphoproliferative Disorders: Report From the PTLD. Int Survey

Abstract

Objectives: Owing to the rare incidence of posttransplant lymphoproliferative disorder of the heart, there is a paucity of data concerning it. In this study, we pooled data from posttransplant lymphoproliferative disorder patients from the existing literature. We sought to analyze and compare characteristics, predictors, and prognoses of patients with posttransplant lymphoproliferative disorder of the heart.

Materials and Methods: A comprehensive search was made to gather data by PubMed and Google for reports of lymphoproliferative disorders occurring in transplant patients occurring within the heart, the heart allograft, and surrounding tissues. Pooled data were reanalyzed.

Results: Overall, 206 patients were entered into the analysis. Transplant recipients with cardiac posttransplant lymphoproliferative disorders were significantly more likely to represent multivisceral and disseminated posttransplant lympho­proliferative disorder (P = .01 and P < .001). Posttransplant lymphoproliferative disorder in patients with heart involvement were more likely to involve the genitalia (P = .035), the adrenals (P = .035), the liver (P = .007), and the kidneys (P < .001). Patients with cardiac posttransplant lympho­proliferative disorder had significantly shorter time from transplant to development of posttransplant lymphoproliferative disorder (P = .029). A log-rank test showed a significant inferior patient survival for transplant recipients with cardiac complications (P = .031). Patients with a cardiac allograft posttransplant lymphoproliferative disorder were significantly older at the time of transplant (55.3 ± 8.4 vs 38.5 ± 21.8 y; P = .002).

Conclusions: Because cardiac posttransplant lymphoproliferative disorder is associated with multiorgan and disseminated posttransplant lymphoproliferative disorder, all transplant recipients who represent posttransplant lympho­proliferative disorder in the heart should be evaluated for other organs involvement most especially in the kidneys, liver, and adrenals. Further prospective studies with a larger patient population are needed to confirm our results.