Comparison of Post-Transplantation Lymphoproliferative Disorder Risk and Prognostic Factors between Kidney and Liver Transplant Recipients.

Abstract

Simple SummaryOrgan graft type is an independent risk factor for the development of PTLD. Due to small cohort sizes caused by the rarity of the disease, most studies and trials are performed on populations of recipients of various organ graft types. Our study is a first direct comparison of the effect of different risk and prognostic factors between kidney and liver transplant recipients (KTRs and LTRs, respectively). We have demonstrated that the analysis of risk factors based on the general solid organ transplant recipient population is inconsistent with the results obtained through the analysis of single organ graft type cohorts. The risk of PTLD is lower in KTRs who are female, <45 years old at transplantation, or treated with cyclosporin. Based upon our findings, we are confident that the type of organ graft is an overriding factor in PTLDs’ development and course.Post-transplantation lymphoproliferative disorder (PTLD) is a life-threatening complication of solid organ transplantation (SOT). Its development risk varies among organ graft recipients. In this study, retrospective data were analyzed to compare PTLD’s risk and prognostic factors between adult kidney and liver transplant recipients (KTRs and LTRs, respectively). Over 15 years, 2598 KTRs and 1378 LTRs were under observation at our center. Sixteen KTRs (0.62%) and twenty-three LTRs (1.67%) were diagnosed with PTLD. PTLD developed earlier in LTRs (p < 0.001), SOT patients > 45 years old (p = 0.002), and patients receiving tacrolimus (p < 0.001) or not receiving cyclosporin (p = 0.03) at diagnosis. Tacrolimus use, male sex, and age > 45 years old significantly affected the time of PTLD onset in KTRs (hazard ratio (HR) = 18.6, 7.9 and 5.2, respectively). Survival was longer in LTRs < 45 years old (p < 0.009). LTRs were more likely than KTRs to achieve complete remission (p = 0.039). Factors affecting PTLD development and outcome differ between KTRs and LTRs; thus, these populations should be separately evaluated in future studies.