Post-transplant lymphoproliferative disorder-related admissions in the United States.

Abstract

e19071 Background: Post-transplant lymphoproliferative disorders (PTLD) is an immunosuppression-related malignancy complicating solid organ transplant (SOT) and non-solid organ transplant (NSOT) (peripheral stem cell and bone marrow transplant). The epidemiology of PTLD-related hospital admissions (PRA) is unclear. The objective of our study is to describe the trend and outcomes of PRA in the United States. Methods: A descriptive, retrospective study was conducted using the National Inpatient Sample database from 2009-2014. PRA were selected using International Classification of Diseases-Ninth Revision, Clinical Modification diagnosis code (238.77). Multivariate regression analysis was performed to determine mortality and length of stay (LOS) in PRA. Results: The incidence of PRA in transplant-related hospital admissions was 7.19 per thousand admissions (pta) in 2009 and 7.24 pta in 2014 with annual percentage change (APC) of 0.1% (p = 0.9). The median age of patients with PRA was 47 (25-75 percentile: 19-61) years, 38.8% were females, 69.9% were white and 10.7% were African-American. Among patients with PRA, 91.1% had SOT [kidney (31.4%), liver (20.9%), heart (14.6%), lung (7%) and small intestines (1.89%)]; 7.1% had NSOT [bone marrow (3.9%) and peripheral stem cell (2%)] and 1.8% had two or more organ transplants. The most common principal diagnosis in PRA were complications of organ transplant (33.3%), encounter for anti-neoplastic chemotherapy (11.4%), neutropenia (5%), acute kidney injury (3.7%) and hearing loss (1.7%). Among transplant-related hospital admissions, PRA had higher adjusted odds of inpatient mortality [Odds ratio (OR) 2.57 (Confidence Interval (CI) 1.69-2.42), p < 0.001] and longer LOS [4.22 days (CI 3.26-5.17), p < 0.001] than non-PRA. Among PRA, those with NSOT have higher adjusted odds of mortality [OR 2.98 (CI 1.07-8.29), p = 0.036] and longer LOS [16.27 days (CI 3.51-29.03), p < 0.013] compared to those with SOT. Conclusions: PRA have higher odds of mortality and longer LOS compared to other transplant-related hospital admissions. Even though SOT accounts for most of the PRA, the adjusted odds of mortality are significantly higher in PRA with NSOT.