Incidence and outcomes of post-transplant lymphoproliferative disorders in lung transplant patients: analysis of ISHLT Registry

Abstract

ABSTRACTBackgroundPost-transplant lymphoproliferative disorder (PTLD) is a life-threatening complication following lung transplant. We aimed to study the incidence of and risk factors for PTLD in adult lung transplant recipients.MethodsThe International Society of Heart and Lung Transplant (ISHLT) Registry was used to identify adult, first-time, single and bilateral lung transplant recipients with at least one year follow-up and from centers reporting PTLD between January 2006 and June 2015. Kaplan Meier method was used to describe timing and distribution of PTLD. Univariable and multivariable Cox proportional hazards regression models were used to examine the clinical characteristics associated with PTLD.ResultsOf the 19,309 lung transplant recipients in the analysis cohort, we identified 454 cases of PTLD. Cumulative incidence of PTLD was 1.1% (95% CI = 1.0%, 1.3%) at 1 year and 4.1% (95% CI= 3.6%, 4.6%) at 10-years. We observed that 47.4% of all PTLD cases occurred within the first year following lung transplantation. In the multivariable model, independent risk factors for PTLD included age, EBV mismatch and native lung diseases. The risk of PTLD during the first year after transplant increased with increasing age in patients between 45 to 62 years at time of transplantation; the inverse was true for ages less than 45 year or greater than 62 years. Finally, receiving a donor organ with human leukocyte antigen (HLA) types A1 and A24 was associated with an increased risk of PTLD while the recipient HLA type DR11 was associated with a decreased risk.ConclusionsOur study indicates that PTLD is a relatively rare complication among adult lung transplant recipients. We identified clinical characteristics that are associated with increased risk of PTLD.