title: Liver transplanted patients with preoperative autoimmune hepatitis and immunological disorders are at increased risk for Post-Transplant Lymphoproliferative Disease (PTLD).
abstract: BACKGROUND
  Long term immunosuppression and therapy of acute rejections result in a 20-120-fold increased risk to develop Non Hodgkin lymphoma (NHL). Since immunosuppressive therapy and immunological disorders are major risk factors for the development of NHL in the non-transplant population we aimed to analyze risk factors for PTLD in our cohort of liver transplanted (LT) patients.
  
  
  METHODS
  We analyzed retrospectively 431 patients liver transplanted between 1998 and 2008.
  
  
  RESULTS
  PTLD was diagnosed in eleven of 431 patients (2.6%). PTLD, especially late PTLD, was significantly more frequent in patients who received steroids before LT (Kaplan-Meier: p<0.001). Moreover PTLD in immunocompromised patients with preoperative steroid treatment occurred at a significantly younger age (49.5+/-4.7 years) compared to patients without steroids (60.6+/-5.1 years; p=0.006). Multivariate analysis revealed pretransplant steroid treatment and liver transplantation for autoimmune hepatitis as main risk factors for the development of PTLD after liver transplantation (p<0.001).
  
  
  CONCLUSIONS
  Liver transplanted patients who received steroids before LT due to immunological disorders and patients with autoimmune hepatitis seem to be at particular high risk to develop PTLD. Prospective cohort studies including immunoepidemiologic investigations of abnormalities of cellular, humoral and innate immunity should be carried out to identify predictive factors and patients at risk.
authors.affiliation: 1st Department of Medicine, Hepatology, University of Mainz, Germany.
authors.forename: Tim
authors.initials: T
authors.lastname: Zimmermann
authors.forename: Maria
authors.initials: M
authors.lastname: Hoppe-Lotichius
authors.forename: Vuk
authors.initials: V
authors.lastname: Tripkovic
authors.forename: Ana P
authors.initials: AP
authors.lastname: Barreiros
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Wehler
authors.forename: Anca
authors.initials: A
authors.lastname: Zimmermann
authors.forename: Jörn M
authors.initials: JM
authors.lastname: Schattenberg
authors.forename: Michael
authors.initials: M
authors.lastname: Heise
authors.forename: Stefan
authors.initials: S
authors.lastname: Biesterfeld
authors.forename: Peter R
authors.initials: PR
authors.lastname: Galle
authors.forename: Gerd
authors.initials: G
authors.lastname: Otto
authors.forename: Marcus
authors.initials: M
authors.lastname: Schuchmann
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002102:Cadaver; D002648:Child; D005260:Female; D019693:Hepatitis, Autoimmune / Q000188:drug therapy / Q000276:immunology / Q000401:mortality*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D053208:Kaplan-Meier Estimate; D016031:Liver Transplantation / Q000401:mortality* / Q000706:statistics & numerical data*; D008228:Lymphoma, Non-Hodgkin / Q000276:immunology / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000276:immunology / Q000401:mortality*; D011300:Preoperative Care; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D013256:Steroids / Q000627:therapeutic use; D014019:Tissue Donors / Q000706:statistics & numerical data; D055815:Young Adult
chemical_list: D007166:Immunosuppressive Agents; D013256:Steroids