Post-transplant lymphoproliferative disease in heart and lung transplantation: Defining risk and prognostic factors

J Heart Lung Transplant. 2015 Nov;34(11):1406-14. doi: 10.1016/j.healun.2015.05.021. Epub 2015 Jun 11.


Background: Heart and lung transplant recipients have among of the highest incidence rates of post-transplant lymphoproliferative disease (PTLD). Despite this, there is a paucity of data specific to this group. We collated data on heart, lung and heart-lung transplant recipients with PTLD to identify disease features and prognostic factors unique to this group of patients.

Methods: Seventy cases of PTLD were identified from a single institution (41 heart, 22 lung, 6 heart-lung and 1 heart-kidney transplant) from 1984 to 2013. Demographics, immunosuppression, treatment, response, complications and survival data were analyzed. Uni- and multivariate Cox regression analyses were performed to identify prognostic factors.

Results: The incidence of PTLD was 7.59% in heart-lung, 5.37% in heart and 3.1% in lung transplant recipients. Extranodal disease (82%) with diffuse large B-cell lymphoma (72%) was the most common presentation. Bone marrow involvement (13%) and central nervous system disease (3%) were uncommon. Heart transplant recipients had later onset of PTLD (>1 year post-transplant), with less allograft involvement, compared with lung and heart-lung recipients. Poor prognostic markers were bone marrow involvement (HR 6.75, p < 0.001) and serum albumin <30 g/liter (HR 3.18, p = 0.006). Improved survival was seen with a complete response within 3 months of treatment (HR 0.08, p < 0.001). Five-year overall survival was 29%.

Conclusion: This analysis is the largest to date on PTLD in heart and lung transplant recipients. It provides a detailed analysis of the disease in this group of patients and identifies unique prognostic features to aid risk stratification and guide treatment allocation.

Keywords: PTLD; heart transplant; lung transplant; post-transplant malignancies.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Biopsy
  • Child
  • Female
  • Graft Rejection / complications*
  • Graft Rejection / diagnosis
  • Graft Rejection / prevention & control
  • Heart Failure / surgery
  • Heart Transplantation / adverse effects*
  • Humans
  • Immunosuppression / methods*
  • Incidence
  • Lung Diseases / surgery
  • Lung Transplantation / adverse effects*
  • Lymphoproliferative Disorders / epidemiology*
  • Lymphoproliferative Disorders / etiology
  • Lymphoproliferative Disorders / therapy
  • Male
  • Middle Aged
  • New South Wales / epidemiology
  • Prognosis
  • Retrospective Studies
  • Risk Assessment / methods*
  • Risk Factors
  • Survival Rate / trends
  • Transplantation, Homologous
  • Young Adult