Infect Chemother.  2006 Jun;38(3):131-139.

Clinical Manifestations of Posttransplantation Lymphoproliferative Disorder (PTLD) after Liver Transplantation

Affiliations
  • 1Division of Infectious Diseases, Department of Internal Medicine, Konkuk University, Korea.
  • 2Division of Infectious Diseases, Sungkungkwan University School of Medicine, Seoul, Korea. krpeck@smc.samsung.co.kr
  • 3Department of Surgery, Sungkungkwan University School of Medicine, Seoul, Korea.
  • 4Department of Pathology, Sungkungkwan University School of Medicine, Seoul, Korea.
  • 5Division of Infectious Diseases, Department of Internal Medicine, InJe University, Busan, Korea.

Abstract

BACKGROUND: Post-transplantation lymphoproliferative disorder (PTLD) after liver transplantation is a rare but potentially fatal disease. Clinical manifestations and prevalence of PTLD after liver transplantation in Korea have not been investigated thoroughly.
MATERIALS AND METHODS
A retrospective chart review was done for 284 liver transplant recipients at Samsung Medical Center, Seoul, Korea during the period from 1996 to 2003.
RESULTS
The incidence of PTLD after liver transplantation was 3.9% (11/284). PTLDs were more prevalent in children (9/55, 16.4%) than in adults (2/237, 0.9%; P<0.01). Among the PTLD patients, four cases were male (36.3%) and seven were female (63.7%). Median time from the transplantation to PTLD diagnosis was 9 months. The type of PTLD was as follows:early lesion (6 cases, 54.5%), polymorphic PTLD (3 cases, 27.3%), and B cell lymphoma (2 cases, 18.2%). PTLDs were more prevalent in the patients with cyclosporine use (OR 13.28, 95% CI:1.29-136.31, P=0.03), acute rejection (OR 5.63, 95% CI:1.03-30.62, P=0.04), and negative serology for EBV VCA IgG (OR 19.15, 95% CI:1.99-183.98, P=0.01) by multivariate logistic regression. Three patients (27.3%) died of B cell lymphoma (2 cases) and polymorphic PTLD (1 case). The remaining patients were improved with reduction of immunosuppression and treatment with acyclovir.
CONCLUSION
The incidence of PTLD was high in children. The risk factors of PTLD were negative serology for EBV VCA IgG, history of acute rejection, and cyclosporine use. Considering the poor prognosis of PTLD, effective strategies for prevention and early diagnosis for early treatment should be emphasized.

Keyword

Liver transplantation; Post-transplant lymphoproliferative disorder (PTLD); EBV

MeSH Terms

Acyclovir
Adult
Child
Cyclosporine
Diagnosis
Early Diagnosis
Female
Herpesvirus 4, Human
Humans
Immunoglobulin G
Immunosuppression
Incidence
Korea
Liver Transplantation*
Liver*
Logistic Models
Lymphoma, B-Cell
Lymphoproliferative Disorders*
Male
Prevalence
Prognosis
Retrospective Studies
Risk Factors
Seoul
Transplantation
Acyclovir
Cyclosporine
Immunoglobulin G
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