Korean J Transplant.  2022 Nov;36(Supple 1):S230. 10.4285/ATW2022.F-3703.

De novo posttransplant lymphoproliferative disorders in heart transplant recipients: predictors and clinical outcomes

• Kim SH
• Youn JC
• Kim IC
• Kim D
• Lee S
• Kim JJ
• Jung MH
• Rossano JW
• Cherikh WS
• Stehlik J

• KMID: 2535447
• DOI: http://doi.org/10.4285/ATW2022.F-3703

Abstract

Background
Posttransplant lymphoproliferative disorder (PTLD) is a major cause of morbidity and mortality in heart transplant (HTx) recipients. However, the real-world clinical profiles and predictors of PTLD have not been well studied.
Methods
We retrospectively analyzed clinical characteristics, predictors, and outcomes of PTLD in 28,136 heart alone trans-plants recipients between January 2000 and June 2015 from the International Society for Heart and Lung Transplantation Tho-racic Organ Transplant Registry, with minimal exclusion.
Results
Ten-year incidence of PTLD after successful discharge from HTx during 2000–2007 was 3.8%. The adjusted overall risk of mortality was significantly higher in patients with PTLD within 3 years after HTx, compared to those without PTLD (HR, 2.42; 95% CI, 2.01–2.91; P<0.001). Bimodal peak of recipient age was noted regarding both PTLD incidence and mortality within the 3 years of HTx. Both adjusted risk of PTLD development and mortality were lower in recent era of HTx in 2008–2015, com-pared with earlier era of 2000–2007 (incidence: HR, 0.75; 95% CI, 0.57–0.98; P=0.038) (mortality: HR, 0.86; 95% CI, 0.81–0.91; P<0.001). Recipients age at transplant, male recipient, high risk Epstein-Barr virus (EBV) mismatch (donor positive and recipient negative for EBV) were independent risk factors for PTLD within 3 years, while primary maintenance therapy with cyclosporine (vs. tacrolimus) at initial discharge was found to be a protective factor.
Conclusions
The incidence as well as mortality of PTLD has decreased in recent years of HTx, possibly with tailored peri-transplant management and advances in immunosuppressive strategies. Clinical characteristics such as recipient age, male recipients, and EBV status mismatch are key factors for assessing the risk of PTLD, associated with detrimental course in post-HTx care. These findings will guide clinicians to identify high risk PTLD patients, and assist tailored peri- and long-term post HTx management with vigilant surveillances for PTLD.