Development of lymphoproliferative disease after liver transplantation.
BACKGROUND
Malignancies are a serious long-term complication among liver transplant recipients, with an overall incidence of 4.5%-15%. Posttransplantation lymphoproliferative disease (PTLD) is one of the leading causes of late death. Its development is related to complex interactions between immunosuppressive drugs and environmental agents. The aim of this study was to analyze risk factors for PTLD and survival after orthotopic liver transplantation (OLT) compared with solid tumors.


METHODS
We undertook a retrospective review of the clinical histories of adult patients who underwent OLT between July 1986 and February 2001, and who had been followed until 2005. This study comprised 528 adult recipients who survived more than 2 months after OLT. We excluded pediatric, partial-organ, and multiorgan recipients.


RESULTS
No differences were observed concerning gender, viral etiology of hepatitis, calcineurin inhibitor regimen, or steroid maintenance period. Treated acute rejection episodes accounted for 53.3% of patients who developed PTLD compared with 47.3% in the control group (P = .787). Patients with solid tumors were older at the time of diagnosis than those with PTLD (57.5 +/- 8.13 years vs 48.8 +/- 13.9; P = .002). The overall mortality rate for PTLD was 55.5%, which did not differ significantly from solid tumors.


CONCLUSIONS
PTLD develops in younger patients after OLT. Various immunosuppressive regimens do not seem to influence the incidence of PTLD or other solid tumors.
Marqués
E
E
Servicio de Cirugá General, Ap. Digestivo y Trasplante de Organos Abdominales, Hospital Doce de Octubre, Madrid, Spain. emarquesmedina@hotmail.com
Jiménez
C
C
Manrique
A
A
Vallejo
G H
GH
Clemares
M
M
Ortega
P
P
Moreno
E
E
D000328:Adult; D002294:Carcinoma, Squamous Cell / Q000453:epidemiology; D016572:Cyclosporine / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D006084:Graft Rejection / Q000453:epidemiology / Q000517:prevention & control; D006801:Humans; D007165:Immunosuppression Therapy / Q000379:methods; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use; D015994:Incidence; D016031:Liver Transplantation / Q000009:adverse effects* / Q000276:immunology; D008232:Lymphoproliferative Disorders / Q000453:epidemiology* / Q000401:mortality; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D012878:Skin Neoplasms / Q000453:epidemiology; D016019:Survival Analysis; D017741:Survivors; D016559:Tacrolimus / Q000009:adverse effects / Q000627:therapeutic use
D007166:Immunosuppressive Agents; D016572:Cyclosporine; D016559:Tacrolimus