Post-Transplant Lymphoproliferative Disorder in Lung Transplantation: A Single-Center Experience in Japan

Abstract

<h3>Purpose</h3> Post-transplant lymphoproliferative disorder (PTLD) affects 3-9% of lung transplant (LTx) recipients, with a mortality range of 20-50%. Despite this high morbidity and mortality, few large studies on Asian population are reported, therefore, we lack fixed consensus regarding specific predictive risk factors in LTx recipients. This study was aimed at uncovering the risk factors of PTLD and evaluating the treatment strategy and outcome of Japanese PTLD cases. <h3>Methods</h3> We retrospectively reviewed 195 patients (re-transplantation cases were excluded) who underwent LTx at our hospital between October 1998 and February 2020. <h3>Results</h3> Seven PTLD patients (3.6%) were identified. The indication for LTx in PTLD group was 2 (28.6%), 3 (42.8%), 2 (28.6%) patients for idiopathic pulmonary fibrosis, other interstitial pneumonia including connective tissue disease, lung disease after hematopoietic stem cell transplantation, respectively. The proportion of indication was significantly different from those in non-PTLD patients (p=0.046). All PTLD patients had taken corticosteroid at the time of LTx (p<0.01), and the duration of corticosteroid therapy was significantly longer in the PTLD group (p<0.01). Overall survival after LTx was also significantly worse in the PTLD group (p=0.027). Among 7 PTLD patients, 3 patients died within 1 year after the onset of PLTD, resulting from viral and fungal infection with or without PTLD progression. Remaining 4 patients lived longer than 30 months; however, 3 out of 4 patients developed chronic lung allograft dysfunction (CLAD) after the treatment of PTLD. <h3>Conclusion</h3> Long-term preoperative corticosteroid therapy can be a risk factor of PTLD after LTx. Regardless of the state of PTLD, opportunistic infection was a lethal complication and should be desperately prevented. CLAD may occur at a higher rate after treatment of PTLD, therefore, close monitoring and adjustment of immunosuppressants are needed.