Post-Transplant Lymphoproliferative Disorder in Liver Transplant Recipients: Characteristics, Management and Outcome from a Single-Centre Experience with >1000 Liver Transplantations

Autor: Eberhard L. Renner, Leslie B. Lilly, Max Marquez, Khalid Mumtaz, Alicia Healey, Nabiha Faisal
Jazyk: angličtina
Rok vydání: 2015
Předmět:
Graft Rejection
Male
Epstein-Barr Virus Infections
Pediatrics
Databases
Factual
medicine.medical_treatment
viruses
Liver transplantation
Antibodies
Monoclonal
Murine-Derived
Postoperative Complications
hemic and lymphatic diseases
Antineoplastic Combined Chemotherapy Protocols
Young adult
Incidence
Lymphoma
Non-Hodgkin
Incidence (epidemiology)
Gastroenterology
Immunosuppression
Chemoradiotherapy
General Medicine
Middle Aged
Hodgkin Disease
surgical procedures
operative
Vincristine
Female
Original Article
Lymphoma
Large B-Cell
Diffuse
Rituximab
Immunosuppressive Agents
medicine.drug
Adult
medicine.medical_specialty
animal structures
Calcineurin Inhibitors
Post-transplant lymphoproliferative disorder
Young Adult
medicine
Humans
lcsh:RC799-869
Cyclophosphamide
Aged
Retrospective Studies
Sirolimus
Hepatology
business.industry
Retrospective cohort study
medicine.disease
Lymphoproliferative Disorders
Liver Transplantation
Lymphoma
Doxorubicin
Prednisone
lcsh:Diseases of the digestive system. Gastroenterology
business
Hospitals
High-Volume
Zdroj: Canadian Journal of Gastroenterology and Hepatology, Vol 29, Iss 8, Pp 417-422 (2015)
ISSN: 2291-2797
2291-2789
Popis: BACKGROUND: The literature regarding post-transplant lymphoproliferative disorder (PTLD) in liver transplant recipients (LTRs) is limited.OBJECTIVES: To study the incidence, predictors and outcomes of PTLD after liver transplantation in a single, large-volume centre.METHODS: The charts of all LTRs (n=1372) in the authors’ centre between January 2000 and June 2012 were retrospectively reviewed and those who developed PTLD were identified. Demographic, clinical and treatment data were prospectively collected. Responses to treatment, including complete response, no response, relapse and survival, were recorded.RESULTS: The incidence of PTLD in LTRs was 32 in 1372 (2.3%). Overall, median survival was 37 months (range 0.5 to 195 months), with one-, three- and five-year survival rates of 81%, 74% and 60%, respectively. Epstein-Barr virus (EBV)-negative patients had a better mean (± SD) survival (95±79 months) than EBV-positive patients (41±42 months) (P=0.02). For stage I/II PTLD, one-, three- and five-year actuarial survival was 87%, 87% and 75%, compared with 50%, 30% and 0% for stage III/IV PTLD, respectively (P=0.001). In patients with complete response, median survival was 58 months (range 10 to 195 months); and one-, three- and five-year actuarial survival was 100%, 94% and 76%, respectively, after diagnosis of PTLD. Changing immunosuppression (IS) from calcineurin inhibitor to sirolimus at the time of diagnosis may have improved survival (seven of seven survivors) compared with only decreasing or stopping IS (14 of 25 survivors) (P=0.07).CONCLUSIONS: This series from a single large-volume centre showed excellent short and long-term survival after PTLD in adult LTRs who were EBV negative, had early disease and showed complete response. Consistent with the known in vitro antiproliferative effect of sirolimus, switching IS from calcineurin inhibitor to sirolimus may improve survival.
Databáze: OpenAIRE
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