Does the Organ Matter in PTLD Development in Solid Organ Transplant Recipients? A Multicenter Observational Study of...

The risk of post-transplantation lymphoproliferative disorder (PTLD) varies according to the type of transplanted organ. To investigate the factors contributing to PTLD development and treatment outcomes, we established a multicenter registry that included patients diagnosed with PTLD within a population of 13,263 kidney, liver, and lung transplant recipients (KTRs, LTRs, and LngTRs, respectively), observed in a period between 2000 and 2023.

The chi-squared test was used to analyze differences in group composition. Univariate and multivariate Cox regression were applied to determine the impact of factors upon PTLD onset and patient survival.

Our registry included 58 out of 9432 KTRs, 40 out of 3500 LTRs, and 5 out of 331 LngTRs. The median time to PTLD onset was significantly longer among KTRs (117 months post-transplant) than among LTRs (49 months, p < 0.001) and LngTRs (5 months, p < 0.001). LTRs treated with tacrolimus developed PTLD later compared to LTRs treated with cyclosporin (p = 0.042). In multivariate analysis, older age at first transplantation correlated with earlier disease development in SOTRs (HR = 1.03, p = 0.006) and KTRs (HR = 1.04, p = 0.003). Older age at first transplantation was also associated with worse survival among KTRs (p = 0.045).

We identified clear differences in the factors affecting PTLD onset and survival between KTRs and LTRs. Organ-specific analyses are needed to improve our understanding of PTLD risk factors, treatment choices, and clinical outcomes.