Hepatic involvement by lymphoproliferative disorders post liver transplantation: PTLD.Int. Survey

It is speculated that different localizations of lymphoproliferative disorder after solid organ transplantation (PTLD) have different features and represent specific behavior as well as prognostic individualities.

To compare characteristics of hepatic PTLD (H-PTLD) with non-hepatic PTLD (NH-PTLD) in liver transplant recipients.

We searched PubMed and Google Scholar for all published reports of PTLD in liver recipients within their liver. Reported characteristics of H-PTLD and NH-PTLD were compared.

A total of 21 studies from various countries were found. Overall, 169 liver recipients with PTLD were included in the analysis, of whom 83 (49%) had H-PTLD. Patients with H-PTLD were more likely to test positive for Epstein-Barr virus (EBV) (p < 0.0001), be older at the time of transplantation (p = 0.009), have a shorter time to PTLD development (80 vs. 41% early-onset PTLD; p < 0.001), and have bone marrow involvement (p = 0.03). Multivariate linear regression showed that H-PTLD and EBV positivity, but not age at transplant, were independently associated with time to PTLD development (p = 0.003, p < 0.0001, and p = 1.0, respectively).

Liver transplant patients exhibiting early deterioration of graft function or other hepatic symptoms should, in addition to assessment for rejection, be evaluated for H-PTLD. In addition, all H-PTLD patients should be evaluated for bone marrow involvement, especially if they are EBV positive. Prospective studies with large patient populations are needed to confirm our results.