Post-transplant lymphoproliferative disorder (PTLD) is a devastating complication of solid organ transplant. In liver transplant, studies comparing the risk factors for early vs. late onset PTLD have been limited to single centers. Using a national database, we sought to compare early and late onset PTLD in adult and pediatric liver transplant patients in terms of patient characteristics, immunosuppressive regimens, and mortality.
We conducted a retrospective analysis of the UNOS database to compare early (<1 year) and late (1+ year) onset PTLD in pediatric (<18) and adult (18+) liver transplant patients. We compared patient demographics, co-morbid conditions, immunosuppressive regimens, Epstein-Barr virus (EBV) and cytomegalovirus (CMV) risk status, reason for transplant, and mortality. We categorized EBV and CMV risk status into high, intermediate, and low based on donor and recipient serostatus. Categorical variables were analyzed using FisherÕs exact test. The Kaplan-Meier method, log-rank test, and multivariable Cox regression were used to examine mortality.
92 pediatric patients and 807 adult patients met study criteria. Overall mortality was 35.87% and 53.78% for pediatric and adult patients, respectively. In adults, unadjusted survival was significantly different for early vs. late onset PTLD (p < 0.001; Figure 1); the latter was associated with a 64.33% decreased mortality risk (95% CI: 51.17% to 73.95%; p < 0.001). There was no difference in mortality in pediatric patients (p = 0.549). In neither population was EBV risk status associated with early vs. late onset PTLD. In adults, tacrolimus, mycophenolate mofetil (MMF), and steroid maintenance therapy were associated with late onset PTLD (p < 0.001; 0.006; < 0.001).
We conclude the following- 1) Mortality is greater for early vs. late onset PTLD in adult patients; the converse has been shown previously. 2) Tacrolimus, MMF, and steroids are associated with late onset PTLD in adult patients. 3) EBV risk status did not differ between early and late onset PTLD in both the adult and pediatric populations. This contradicts established reports that EBV negative serostatus of the recipient at the time of transplant is a risk factor for early onset PTLD.
Figure 1 Ð
M. Hagan, None
R. Vivekanandan, None
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