Post-Transplant Lymphoproliferative Disorders after Living-Donor Liver Transplantation: A Retrospective Cohort Study in 1,900 Cases of Single Center Experience
1Div. of HBP Surgery and Transplantation, Dept. of Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan, 2Dept. of Diagnostic Pathology, Kyoto University Hospital, Kyoto, Japan, 3Dept. of Hematology and Oncology, Kyoto University Graduate School of Medicine, Kyoto, Japan
Meeting: 2019 American Transplant Congress
Abstract number: D336
Keywords: Epstein-Barr virus (EBV), Lymphoproliferative disease, Post-operative complications, Post-transplant malignancy
Session Information
Session Name: Poster Session D: PTLD/Malignancies: All Topics
Session Type: Poster Session
Date: Tuesday, June 4, 2019
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Hall C & D
*Purpose: Post-transplant lymphoproliferative disorders (PTLD) is relatively rare but the most common, life-threatening neoplasms after organ transplantation. Because of their heterogeneity from benign to malignant characteristics, its prevalence, outcomes, and clinicopathological features have not been fully elucidated.
*Methods: We retrospectively reviewed 1,900 liver transplant (LT) recipients (884/1,016 for child [<16 years]/adult cases, and 1,831/69 for living-donor LT (LDLT)/deceased donor LT, respectively) in our center from 1990 to 2017. Post-transplant lymphadenopathy, such as Epstein-Barr virus-negative lymphadenitis and lymphoma, were regarded as “PTLD-like” lesions and included in PTLD, because of the similar biological behavior.
*Results: A total of 77 lesions of post-LT PTLD were identified in 70 patients, all of which developed after LDLT (4.2%). Prevalence of PTLD significantly worsened recipient survival after LT (P=0.016, Fig.1-A). Seven metachronous lesions in the same patients and three autopsy cases were excluded to identify prognostic factors. Similarly, 14 deaths of other causes but PTLD were treated as “censored”. 67 cases were enrolled in the final analyses. The median age at LT and PTLD diagnosis was 2.1 years (IQR, 0.9-45.2) and 6.1 years (IQR, 1.9-53.4), respectively. The primary diseases were biliary atresia (38), HCV (8), acute liver failure (6), etc. The median survival was 60 (9-195) months. In univariate analysis, risk factors for patient survival were recipient age ≥16 years at PTLD diagnosis (HR 8.34 [95% CI 2.17-32.11], P =0.002), the presence of extranodal sites (HR 3.86 [1.15-12.95], P =0.029), and monomorphic PTLD (HR 6.29 [1.89-20.73], P =0.003). Multivariate analysis demonstrated that age ≥16 yearsat diagnosis (HR 12.55 [2.27-69.36], P =0.004)and monomorphic PTLD(HR 9.53 [1.53-59.20], P =0.016) were independent risk factors for overall survival. The combination of these two factors effectively stratified patient prognosis into 3 groups(P <0.0001, Fig.1-B).
*Conclusions: Prevalence of PTLD after LDLT was 4.2%, which significantly worsened recipient survival after LT. Age ≥16 yearsat diagnosis and monomorphic PTLD were independent risk factors for patient survival.
To cite this abstract in AMA style:
Tajima T, Hata K, Haga H, Nishikori M, Kusakabe J, Tamaki I, Ito T, Kaido T, Takaori-Kondo A, Uemoto S. Post-Transplant Lymphoproliferative Disorders after Living-Donor Liver Transplantation: A Retrospective Cohort Study in 1,900 Cases of Single Center Experience [abstract]. Am J Transplant. 2019; 19 (suppl 3). https://atcmeetingabstracts.com/abstract/post-transplant-lymphoproliferative-disorders-after-living-donor-liver-transplantation-a-retrospective-cohort-study-in-1900-cases-of-single-center-experience/. Accessed November 22, 2024.« Back to 2019 American Transplant Congress