Korean J Transplant.  2022 Nov;36(Supple 1):S120. 10.4285/ATW2022.F-2396.

Posttransplant lymphoproliferative disorders after solid organ and hematopoietic stem cell transplantation: a nationwide cohort study in Korea

• Ihn K
• Hahn SM
• Lee M
• Kim EH
• Kang JM
• Lim SM
• Joo DJ
• Jung I

• KMID: 2535636
• DOI: http://doi.org/10.4285/ATW2022.F-2396

Abstract

Background
osttransplant lymphoproliferative disorders (PTLD) are the majority of cancer diagnoses after solid organ trans-plantation (SOT) and allogeneic hematopoietic stem cell transplantation (HSCT) with a high incidence of PTLD developed in the first posttransplant year. However, there is minimal nationwide literature examining the incidence and risk analysis of PTLD. We investigated the incidence and risk determinants of PTLD in Korean SOT and HSCT recipients using a large national database.
Methods
This study recruited 47,518 patients (SOT, 36,945; HSCT, 10,573) from the Korean National Health Insurance Service database between 1 January 2009 and 31 December 2020. Patients previously diagnosed with hematologic or lymphoprolifer-ative malignancies or multi-organ transplant recipients were excluded.
Results
PTLD developed in 529 patients (SOT, 294; HSCT, 235). According to the type of transplant, PTLD after HSCT was the most common (2.22%), followed by heart (1.40%), lung (0.97%), liver (0.82%), and kidney (0.64%). The subdistributional hazard ratio (SHR) of PTLD in pediatric patients aged 10 to 19 years was higher than that in those aged 20 to 39 years (SHR, 1.671; P=0.0018; 95% confidence interval [CI], 1.211–2.306). Compared with kidney transplantation, HSCT was associated with a great-er risk of PTLD (SHR, 3.016; P<0.001; 95% CI, 2.399–3.791). The hazard ratio (HR) of death after diagnosing PTLD in patients aged over 60 years was higher than that in those aged 20 to 39 years (HR, 2.170; P<0.001; 95% CI, 1.999–2.355). Compared with kidney transplantation, HSCT was associated with a greater risk of death after PTLD (HR, 9.954; P<0.001; 95% CI, 9.259–10.701).
Conclusions
This nationwide population-based cohort study revealed that PTLD was associated with a higher risk in the pediat-ric age group. According to the type of transplantation, HSCT was at greater risk of developing PTLD and death after diagnosing PTLD than SOT.