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Post-Transplant Lymphoproliferative Disorder: A Retrospective 17-Year Analysis
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A4539 - Post-Transplant Lymphoproliferative Disorder: A Retrospective 17-Year Analysis
Author Block: J. W. Whitson1, L. D. Snyder2, L. Zaffiri3; 1Pulmonary and Critical Care Medicine, Duke University, Durham, NC, United States, 2Duke Univ Med Ctr, Durham, NC, United States, 3Duke University, Durham, NC, United States.
Rationale: Post-transplant lymphoproliferative disorder (PTLD) is a serious and often fatal complicating of lung transplantation. The risk of developing PTLD has been associated to the organ transplanted and the degree of immunosuppression. We present a retrospective analysis of 31 patients diagnosed with PTLD following lung transplantation at Duke.
Methods: Post-transplant patients were retrospectively identified via electronic medical record from the years 1998 to 2017. Chart review confirmed details of diagnosis, treatment, EBV status, and survival. Descriptive statistics were used to characterize the cohort. Survival analysis was performed using the Kaplan Meier method to estimate overall survival. Cox regression model was used to estimate the association between death and graft involvement of PTLD and increased immunosuppression 12 months prior to PTLD diagnosis.
Results: The median age of the patients at time of PTLD diagnosis was 52.5 years-old (range 20 to 77 years old). Bilateral lung transplant was performed in 25 patients (80%). 22 patients (70%) were EBV IgG positive at time of transplant. The median interval between transplantation and diagnosis of PTLD was 337days (179, 1243 IQR), with 50% of the patients diagnosed within one year of transplantation. PTLD involved the allograft only in 40% of our patients. 21 patients (70%) were receiving a three-drug immunosuppression regimen prior to development of PTLD. Moreover, 7 patients (23%) were treated with higher dose of immunosuppression including methylprednisone or RATG due to rejection within 12 months prior to PTLD diagnosis. The Kaplan-Meier estimate 1 year survival after PTLD diagnosis was 60%. There was no significant association between increased immunosuppression prior to diagnosis of PTLD or graft involvement and death in our cohort.
Conclusion: PTLD is a rare and challenging complication of lung transplantation. Our study suggests that there is no association between graft involvement and death. Survival remains poor. Further work must be done to identify risk factors and optimize treatment strategies for survival improvement.
Author Block: J. W. Whitson1, L. D. Snyder2, L. Zaffiri3; 1Pulmonary and Critical Care Medicine, Duke University, Durham, NC, United States, 2Duke Univ Med Ctr, Durham, NC, United States, 3Duke University, Durham, NC, United States.
Rationale: Post-transplant lymphoproliferative disorder (PTLD) is a serious and often fatal complicating of lung transplantation. The risk of developing PTLD has been associated to the organ transplanted and the degree of immunosuppression. We present a retrospective analysis of 31 patients diagnosed with PTLD following lung transplantation at Duke.
Methods: Post-transplant patients were retrospectively identified via electronic medical record from the years 1998 to 2017. Chart review confirmed details of diagnosis, treatment, EBV status, and survival. Descriptive statistics were used to characterize the cohort. Survival analysis was performed using the Kaplan Meier method to estimate overall survival. Cox regression model was used to estimate the association between death and graft involvement of PTLD and increased immunosuppression 12 months prior to PTLD diagnosis.
Results: The median age of the patients at time of PTLD diagnosis was 52.5 years-old (range 20 to 77 years old). Bilateral lung transplant was performed in 25 patients (80%). 22 patients (70%) were EBV IgG positive at time of transplant. The median interval between transplantation and diagnosis of PTLD was 337days (179, 1243 IQR), with 50% of the patients diagnosed within one year of transplantation. PTLD involved the allograft only in 40% of our patients. 21 patients (70%) were receiving a three-drug immunosuppression regimen prior to development of PTLD. Moreover, 7 patients (23%) were treated with higher dose of immunosuppression including methylprednisone or RATG due to rejection within 12 months prior to PTLD diagnosis. The Kaplan-Meier estimate 1 year survival after PTLD diagnosis was 60%. There was no significant association between increased immunosuppression prior to diagnosis of PTLD or graft involvement and death in our cohort.
Conclusion: PTLD is a rare and challenging complication of lung transplantation. Our study suggests that there is no association between graft involvement and death. Survival remains poor. Further work must be done to identify risk factors and optimize treatment strategies for survival improvement.
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