Introduction:

A post transplant lymphoproliferative disorder (PTLD) is an infrequent but serious complication following solid organ transplantation. The incidence varies and depends on the type of organ, degree of immunosuppression and patient’s immune status to Epstein Barr Virus.

Material & Methods:

This is a retrospective data analysis in 5133 patients following kidney (n=3440), liver (n=1145), pancreas (n=519) and intestinal/multivisceral (n=29) transplantation.

In this patient cohort, 54 cases of PTLD have been observed and correlated with

induction therapy, maintenance immunosuppression, EBV status, CMV status, antiviral therapy, acute rejection, graft survival, retransplantation and death.

Results:

The overall cumulative incidence of PTLDs was 1.05% (54/5133); 5 year survival was 25.9% (14/54); (highest in PTX 40% (2/5) and lowest in LTX: 20% (3/15). Overall survival was 2.9 years (0-13). PTLD occurred significantly earlier in patients transplanted after 2000 (101 months vs 23 months). Patient with a higher immunological risk received induction therapy and showed decreased patient and graft survival after kidney transplantation as well as a significantly higher risk for PTLD after liver transplantation. Donor age had an impact on graft survival, PTLD onset and patient survival following pancreas transplantation. Interestingly, prognosis was poor in early PTLD and more favorable in late PTLD (all p<0.05).

Discusssion:

We have identified a correlation between organ, patient age and induction therapy with PTLD development in a large single center analysis. A shift of PTLD occurrence towards later time points after transplantation with a more favorable outcome was observed in this study.

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