Early versus late outset of lymphoproliferative disorders post-heart and lung transplantation: the PTLD.Int Survey

ABSTRACT

The presentation time of post-transplantation lymphoproliferative disorders [PTLD] are not well described because of the limited number of cases occurring at each center and lack of a reliable and unequivocal classification together with the absence of multi-institutional prospective studies. We gathered information on the histopathological and clinical features and prognosis of the disease in a very large number of heart and lung transplant recipients, with data from 27 previous reports, with an emphasis of time of presentation. Retrospective analysis of data for individual patients from published studies entered into a database and reanalyzed. A comprehensive review of the literature by PubMed and Google Scholar was performed to find all data available reports on PTLD after heart and lung transplantation. Data from 288 PTLD patients after heart or lung transplantation from 27 reports were entered into analysis. Heart and lung recipients with early-onset PTLD compared with late-onset PTLD were significantly more likely to be of the B cell type [100% vs. 89.8%, respectively; P=.05]. PTLD in patients with early onset was less likely to involve the skin [P=.05] and spleen [P=.015], but more frequently complications of the respiratory tract [P=.002]. Morphology of PTLD lesions was significantly different between the two groups with a priority for late-onset PTLD to represent non-Hodgkin lesions [P=.009]. No difference was found between the two groups in survival [P=.237]. One and five-year survival rates for early-onset PTLD patients were 65% and 46%, respecttively; compared to 53% and 41%, respectively, for the late-onset PTLD. Due to a higher incidence of respiratory tract involvement in the early-onset PTLD patients and skin and spleen involvement in late-onset PTLD, we suggest that all heart/lung graft recipients should be evaluaated for potential multiorgan disease based early or late presentation. Further multi-institutional prospective studies are needed to confirm our results: