Predictors and Clinical Outcomes of Lymphoproliferative Disorders in Heart Transplant Recipients

Abstract

Post-transplant lymphoproliferative disorder (PTLD) is an important cause of morbidity and mortality in cardiac transplant recipients. However, the incidence and predictors of PTLD in the real world has not been well studied. We analyzed the temporal trends, clinical characteristics, predictors, and clinical outcomes of PTLD using 28,136 recipients of deceased donor, heart alone transplants between 2000 and June 2015 from the International Society for Heart and Lung Transplantation Thoracic Organ Transplant Registry. Ten-year incidence of PTLD after successful discharge for transplants during 2000-2007 was 3.8%. The adjusted overall risk of mortality was significantly higher in patients who had PTLD within 3 years after heart transplantation compared to those with no PTLD (HR 2.22, 95% CI 1.86-2.65, p<0.001). The adjusted risk of PTLD was lower for transplants in 2008-2015 vs. 2000-2007 period (HR 0.75, 95% CI 0.57-0.98, p=0.038). Risk mortality was also lower for transplants in 2008-2015 vs. 2000-2007 period (HR 0.86, 95% CI 0.81-0.91, p<0.001). Age at transplant, male gender, Epstein-Barr virus (EBV) mismatch (donor EBV (+), recipient EBV (-)), and use of discharge cyclosporin were independent risk factors for PTLD. Treated acute rejection within 1-year was significantly related with increased rate of PTLD within 3 years (1.4% vs. 0.9%, p<0.001) (Figure 1). The incidence as well as mortality of PTLD has decreased in recent years. Close observation and balanced immunosuppression according to the patient's characteristics such as age, gender, EBV status and rejection history is the key to decrease the burden of PTLD which can be detrimental in the course of heart transplantation.