Risk Factors for Post-Transplant Lymphoproliferative Disorders in Epstein-Barr Virus Mismatch Lung Transplant Recipients.
Brigham and Women's Hospital, Boston
Meeting: 2017 American Transplant Congress
Abstract number: 158
Keywords: Epstein-Barr virus (EBV), Immunosuppression, Lung transplantation, Post-transplant lymphoproliferative disorder (PTLD)
Session Information
Session Name: Concurrent Session: Lung Transplantation from Donation to Retransplantation
Session Type: Concurrent Session
Date: Sunday, April 30, 2017
Session Time: 4:30pm-6:00pm
Presentation Time: 5:42pm-5:54pm
Location: E270
Background: Post-transplant lymphoproliferative disorders (PTLD) are associated with significant morbidity and morality. Lung transplant patients appear to have higher rates of PTLD than other solid organs recipients, especially among Epstein-Barr virus (EBV) serologic status mismatch patients (donor EBV positive, recipient EBV negative). Although EBV negative status is not considered an absolute contraindication to transplant with an EBV positive donor, there are few data to identify other risk factors for PTLD among EBV negative patients such that transplant from an EBV positive donor should be avoided, if possible.
Methods: This was a retrospective cohort study of EBV mismatch lung transplant recipients 18 years or older who were listed in the Scientific Registry of Transplant Recipients (SRTR) and who underwent lung transplant between May 5th 2005 and October 24th 2016.
Results: Of the 19831 lung transplants reviewed, 1535 (7.7%) involved EBV mismatch recipients. There were follow-up data available for 1113 (72.5%) of these recipients, of whom 66 (5.9%) developed PTLD compared to 1.5% of non-EBV mismatch patients (p<0.001). Pre-transplant variables associated with the development of PTLD in mismatched patients are listed in Table 1. On multivariate analysis, age <40 (OR=2.1 95% CI=1.2-3.7, p=0.01) and non-ABO identical donor (OR 2.7 95% CI=1.6-4.4, p=0.001) were associated with increased odds of developing PTLD. The incidence of PTLD in patients with both risk factors was 22.2%.
Conclusions: There is a significant risk of PTLD in EBV negative patients under the age of 40 who undergo lung transplant with a non-ABO identical, EBV positive donor. For these patients, transplant from an EBV positive donor should be avoided, if possible.
| No PTLD | PTLD | P | |
| Age <40 | 261 (24.9%) | 31 (47.0%) | <0.001 |
| White race | 957 (91.4%) | 65 (98.5%) | 0.04 |
| COPD | 235 (22.4%) | 9 (13.6%) | 0.09 |
| CMV D+/R- | 297 (31.9%) | 26 (43.3%) | 0.07 |
| Chronic steroids before transplant | 467 (46.1%) | 25 (37.9%) | 0.20 |
| Non-ABO identical donor | 121 (11.5%) | 15 (22.7%) | 0.01 |
| Greater than 4 HLA mismatches | 531 (57.1%) | 33 (60.0%) | 0.67 |
CITATION INFORMATION: Courtwright A, Burkett P, Camp P, Divo M, El-Chemaly S, Keller S, Mody G, Rosas I, Singh S, Goldberg H, Mallidi H. Risk Factors for Post-Transplant Lymphoproliferative Disorders in Epstein-Barr Virus Mismatch Lung Transplant Recipients. Am J Transplant. 2017;17 (suppl 3).
To cite this abstract in AMA style:
Courtwright A, Burkett P, Camp P, Divo M, El-Chemaly S, Keller S, Mody G, Rosas I, Singh S, Goldberg H, Mallidi H. Risk Factors for Post-Transplant Lymphoproliferative Disorders in Epstein-Barr Virus Mismatch Lung Transplant Recipients. [abstract]. Am J Transplant. 2017; 17 (suppl 3). https://atcmeetingabstracts.com/abstract/risk-factors-for-post-transplant-lymphoproliferative-disorders-in-epstein-barr-virus-mismatch-lung-transplant-recipients/. Accessed November 22, 2024.« Back to 2017 American Transplant Congress