A systematic review of post-transplant lymphoproliferative disorder after liver transplant.

Authors

null

Mobeen Zaka Haider

King Edward Medical University, Lahore, Pakistan

Mobeen Zaka Haider , Zarlakhta Zamani , Hasan Mehmood Mirza , Hafsa Shahid , Muhammad Taqi , Yousra Khalid , Mohsin Sheraz Mughal , Fnu Kiran , Deepak Kumar , Ahsan Wahab , Muhammad Salman Faisal , Muhammad Umair Mushtaq , Faiz Anwer

Organizations

King Edward Medical University, Lahore, Pakistan, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA, Mayo Hospital, Lahore, Pakistan, Rutger/RWJ/Monmouth Medical Center, Long Branch, NJ, Department of Pathology, Sindh Institute of Urology and Transplantation, Karachi, Pakistan, Jinnah Postgraduate Medical Center, Karachi, Pakistan, Baptist Medical Center South/University of Alabama Birmingham, Montgomery, AL, Department of Hematology, BMT, Ohio State University, Columbus, OH, Division of Hematologic Malignancies and Cellular Therapeutics, University of Kansas Medical Center, Kansas City, KS, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH

Research Funding

No funding received
None

Background: Post-transplant lymphoproliferative disorder (PTLD) is a complication after liver transplantation. This study aims to explore the association of PTLD with the immunosuppression, types of PTLD, clinical presentation, and outcomes. Methods: Following the PRISMA guideline, we searched the literature on PubMed, Cochrane, Embase, and clinicaltrials.gov. 1741 articles were screened and 22 studies were included. Results: Data includes 22,235 total patients who underwent a liver transplant, and 449 (2.0%) patients who developed PTLD were studied. Of the 394 patients where gender was reported, 226 were male and 168 were female. Post-transplant EBV status was positive for 63/115 (56%). 11 studies showed that the median time from transplant to the development of PTLD was 33.4 months. Among the histological types of PTLD, the monomorphic B-cell was the most common type with 127/235 (54%) cases, followed by early lesions 25/235, polymorphic 24/235, Hodgkin lymphoma 8/235, and monomorphic T-cell type 7/235. Treatment of PTLD involved reduction or cessation of the immunosuppressive drugs along with chemotherapy surgery and radiotherapy. Mortality data from 13 studies showed 68/259 (31.3%) patients died either due to PTLD or its complication. Conclusions: PTLD is rare but associated with high mortality after liver transplantation. EBV seropositivity is associated with PTLD in the majority of cases. Monomorphic PTLD is the most common type of PTLD after liver transplantation with DLBCL being the most common subtype. Abdominal symptoms and fever are among the most common symptoms. PTLD after Liver transplant a review of studies.

Study
Total n
PTLD patients
M/F
EBV Status
Type of PTLD
Median Duration
Mortality
Fararjeh
45
45
25/20
+ : 16/45
Early:3; Mono B:34; Mono T:2; Poly:4; HL:1
56 m
16/25
Jamalidoust
696
34
17/17
+: 19/34
Mono(DLBCL):5; HL:1; NHL:1; MALT: 1; UC:26

11/34
Dorado
851
10
8/2.
PreTx: D+: 6; R+: 5
Mono: 7; Poly: 2; Early: 1
M: 33 m
5/10
Ozkan
2148
7
4/3
+ : 4/7
MonoB(DLBCL): 4; Mono T: 1; Early lesion:2
M: 75.2 m

Bellido
1071
18
14/4
PreTx: R+: 6; D+:5
Mono B: 12; Mono T: 2; HL:1; Early: 3
3.9 y

Ozkan
2224
12
7/5

Mono B: 5; Mono T: 1; Mixed Mono & Poly: 2; Early lesion: 4
M: 27 m
1/12
Alderuccio
1489
20
15/5
PreTx: D+: 4
Mono; DLBCL: 17; HL: 1; Plasmacytoma: 2;
82 m
8/20
Cruz
5677
36
20/16
PreTx +: 17/36
Monomorphic: 25/36; Early onset: 4/36; Mixed type: 1/36; UC: 1/36
M: 7.2 y

Valls
715
6

PreTx+: 3/6
Mono:5/6 (DLBCL); Plasmacytic: 1/6
14 m
4/6
Pinho-

appezato
303
13

PreTx: D+: 7; R+:3

PostTx: R+: 11/13
Mono B: 7/13 (DLBCL: 4, Burkitt:2, NHL:1) Poly: 6/13
13m
7/13
Hsu
110
16
8/8
PreTx: R+: 1/16;

PostTx R+:15/16
Mono B: 5; Mono Burkitt: 2; Mono T: 1; HL: 1; Poly:6; Early:1
8m
3/16
Huang
110
18
9/9

Mono B: 2; Poly:1; Early: 13; HL: 1
8.9 m
3/18
Karakoyun
206
7
2/5
PreTx: + 3/7
B Cell: 2; T Cell: 1; HL: 2; EBV rel 2
24 m
1/7

DLBCL: diffuse large B cell lymphoma; HL: Hodgkin Lymphoma; M:mean, m: months; NHL: Non-Hodgkin Lymphoma; UC: Unclassified, y: years.

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Abstract Details

Meeting

2021 ASCO Annual Meeting

Session Type

Publication Only

Session Title

Publication Only: Hematologic Malignancies—Leukemia, Myelodysplastic Syndromes, and Allotransplant

Track

Hematologic Malignancies

Sub Track

Other Leukemia, Myelodysplastic Syndromes, and Allotransplant

Citation

J Clin Oncol 39, 2021 (suppl 15; abstr e19045)

DOI

10.1200/JCO.2021.39.15_suppl.e19045

Abstract #

e19045

Abstract Disclosures

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