Early onset post transplantation lymphoproliferative disorders: analysis of international data from 5 studies

Post-transplant lymphoproliferative disease (PTLD) is a major complication after solid organ transplantation and most frequently occurs during the first year post transplantation. We analyzed patient characteristics, outcome and prognostic factors for survival of transplant patients who developed post transplant lymphoproliferative disorders within one year after transplantation reported by 5 major studies worldwide.

We made a comprehensive search for the available data by Pubmed and Google scholar search engines on post transplant lymphoproliferative disorders. A standard questionnaire was developed to collect data from different published studies. Finally, trustable data of a total of 5 publishes were included in the final analysis. For data analysis we used SPSS v. 13.0. Kaplan-Meier Method was used for survival analysis. P<0.05 was defined as significant.

Data of 16 patients who developed PTLD during the early 12 months after transplantation (2 liver and 14 renal) were recruited from 5 studies and entered into analysis. Mean age was 41.9+/-16.2 years. Univariate survival analysis showed that localization of the PTLD in brain in PTLD patients induces a highly significant adverse effect on the outcome of PTLD patients (P=0.008) but not for other localizations. We aso found that involvement of the allograft (all kidney allograft) is associated with higher rate of remission (either partial or complete remission) of PTLDs after anti-cancer therapy. No associations were found regarding other variables.

Because of the higher incidence rate and fatal nature, early onset PTLD is of extreme relevance. Screening all renal transplant patients in the early post transplantation period for an early detection and treatment of PTLDs is crucial, particularly in patients who are more likely to develop PTLDs.