A low incidence of posttransplant lymphoproliferative disorder in 109 lung transplant recipients.
OBJECTIVE
The incidence of posttransplant lymphoproliferative disorder (PTLD) has been reported to range from 6.4 to 20% in lung transplant (LT) recipients. Postulated contributing factors include Epstein-Barr virus (EBV) infection and the use of immunosuppression, particularly muromonab-CD3 (OKT3)(Orthoclone OKT-3; Ortho Biotech; Raritan, NJ). We sought to examine these PTLD risk factors in 109 LT recipients at our institution who survived > 1 month.


METHODS
Retrospective review of EBV serology of all LT recipients at our institution. Our standard transplant protocol includes OKT3 for induction and refractory rejection, as well as lifelong acyclovir for herpes prophylaxis. We do not perform EBV donor-recipient matching.


METHODS
A university-based LT center.


RESULTS
We found that 5 of 109 patients were serologically negative for EBV prior to lung transplantation, and all of these patients converted following lung transplantation. The mean time to conversion was 151 days (range, 11 to 365 days). One fatal case of PTLD was documented in an EBV seroconverter (one of five patients) 12 weeks status posttransplantation for lymphangioleiomyomatosis. One nonfatal extrathoracic PTLD was documented in a seropositive patient (1 of 104 patients) 33 months posttransplantation.


CONCLUSIONS
We conclude the following: (1) PTLD in LT recipients may have a lower incidence (2 of 109 patients; 1.8%) than previously reported, despite an aggressive immunosuppressive regimen; and (2) the incidence of PTLD is higher in patients with primary EBV infection (20% vs 1%).
Levine
S M
SM
Department of Medicine, University of Texas Health Science Center at San Antonio, USA. levines@uthscsa.edu
Angel
L
L
Anzueto
A
A
Susanto
I
I
Peters
J I
JI
Sako
E Y
EY
Bryan
C L
CL
D000328:Adult; D000914:Antibodies, Viral / Q000032:analysis; D004279:DNA, Viral / Q000032:analysis; D020031:Epstein-Barr Virus Infections / Q000453:epidemiology / Q000276:immunology / Q000821:virology; D017809:Fatal Outcome; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000276:immunology / Q000517:prevention & control; D004854:Herpesvirus 4, Human / Q000235:genetics / Q000276:immunology; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D017403:In Situ Hybridization; D015994:Incidence; D016040:Lung Transplantation; D008232:Lymphoproliferative Disorders / Q000453:epidemiology* / Q000276:immunology / Q000821:virology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
D000914:Antibodies, Viral; D004279:DNA, Viral; D007166:Immunosuppressive Agents