2011 - ISBTS 2011 Symposium


Oral Communications 7: Complications

9.161 - Risk factors for posttransplant lymphoproliferative disease after intestinal transplantation

Presenter: Juan Francisco, Guerra, Washington, United States
Authors: Juan Francisco Guerra1,2, Jason Hawksworth1, Lee Cummings1, Raffaele Girlanda1, Eddie Island1, Stuart Kaufman1, Cheryl Little1, Cal Matsumoto1, Thomas Fishbein1


161
Risk factors for posttransplant lymphoproliferative disease after intestinal transplantation

Juan Francisco Guerra1,2, Jason Hawksworth1, Lee Cummings1, Raffaele Girlanda1, Eddie Island1, Stuart Kaufman1, Cheryl Little1, Cal Matsumoto1, Thomas Fishbein1

1Transplant Institute, Georgetown University Hospital, Washington, DC, United States; 2Departamento Cirugia Digestiva, Pontificia Universidad Catolica, Santiago, Chile

Introduction: Posttransplant lymphoproliferative disorder (PTLD) remains a serious complication after intestinal transplantation (ITX). We evaluated risk factors for PTLD development and outcomes.

Methods: We analyzed the clinical features and outcomes of 117 consecutive patients who underwent an ITX with unitivariate analysis. Standard immunosuppression (IS) consisted of basiliximab induction with maintenance consisting of tacrolimus, sirolimus and prednisone. Sensitized patients received anti-thymocyte globulin followed by standard IS. Endoscopic surveillance for PTLD and quantitative EBV monitoring was performed on protocol. All PTLD cases were biopsy proven. Demographics, type of transplant, induction and maintenance IS, rejection rate and its treatment, graft and patient survival were evaluated.

Results: The mean age of the entire cohort was 22.4 years old. The median follow-up was 39 months. The incidence of PTLD was 6.8% (8/117). Six PTLD cases were pediatric recipients, 4 of them were EBV negative and 3 received an EBV positive graft. Both adults were EBV positive before the transplant. In 2 cases PTLD was diagnosed by surveillance endoscopies, 2 cases after lymph node biopsies, 3 after elevated EBV titers and 1 case after graft loss and explant. Three cases died as a consequence of PTLD. 7 patients had monomorphic disease, 2 cases had bone marrow compromise and only 1 patient had CNS involvement. The diagnosis of PTLD in 7/8 cases occurred before 1 year after the transplant. All patients had reduction/withdrawal of IS as initial therapy, followed by rituximab. 4 cases also received concomitant chemotherapy. 1 year graft survival was significantly lower in the PTLD group (p= 0.04). The use of anti-thymocyte globulin as induction IS was the only significant risk factor for the development of PTLD (p= 0.01).

Conclusion: In our experience, the incidence of PTLD after ITX is low. This might be explained by a nondepleting immusuppressive strategy during the induction phase, and by close graft and patient EBV monitoring. The only factor associated with a higher risk of PTLD was the use of anti-thymocyte globulin.


You must be logged in to view recordings

Important Disclaimer

By viewing the material on this site you understand and accept that:

  1. The opinions and statements expressed on this site reflect the views of the author or authors and do not necessarily reflect those of The Transplantation Society and/or its Sections.
  2. The hosting of material on The Transplantation Society site does not signify endorsement of this material by The Transplantation Society and/or its Sections.
  3. The material is solely for educational purposes for qualified health care professionals.
  4. The Transplantation Society and/or its Sections are not liable for any decision made or action taken based on the information contained in the material on this site.
  5. The information cannot be used as a substitute for professional care.
  6. The information does not represent a standard of care.
  7. No physician-patient relationship is being established.

Our Corporate Sponsors

TTS gratefully acknowledges the Corporate Partners whose generous support makes the work of the Society possible:

  • astellas
  • roche
  • sanofi