Post-transplant lymphoproliferative disease in lung transplantation: A nested case-control study

Area of Science:

• Transplantation immunology
• Oncology
• Infectious diseases

Background:

• Post-transplant lymphoproliferative disorder (PTLD) is a serious complication after lung transplantation (LTx).
• PTLD can significantly impact the long-term success of LTx and patient survival.
• Understanding risk factors and outcomes associated with PTLD is crucial for improving patient management.

Purpose of the Study:

• To identify risk factors for developing PTLD in lung transplant recipients.
• To evaluate the impact of PTLD on post-transplant outcomes, including chronic lung allograft dysfunction (CLAD) and survival.
• To compare outcomes between early-onset and late-onset PTLD.

Main Methods:

• A case-control study comparing LTx recipients with PTLD (n=31) to matched controls without PTLD (n=62).
• Assessment of risk factors including Epstein-Barr virus (EBV) status and viral load.
• Analysis of post-transplant outcomes such as time to CLAD and overall survival.

Main Results:

• PTLD prevalence was 3.9% with a median time to onset of 323 days.
• EBV-seronegative status at LTx and higher EBV viral load were significant risk factors for PTLD.
• PTLD patients exhibited significantly shorter time to CLAD onset and poorer 5-year survival (66.6% vs. 91.5%).
• Late-onset PTLD was associated with worse survival compared to early-onset PTLD.

Conclusions:

• Primary Epstein-Barr virus (EBV) infection is a significant risk factor for PTLD in lung transplant recipients.
• PTLD is associated with substantially worse long-term outcomes, including increased risk of CLAD and reduced survival.
• Early identification and management of EBV in LTx recipients may be critical for PTLD prevention and improved outcomes.