Liver transplanted patients with preoperative autoimmune hepatitis and immunological disorders are at increased risk for Post-Transplant Lymphoproliferative Disease (PTLD).
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.
Zimmermann
Tim
T
1st Department of Medicine, Hepatology, University of Mainz, Germany.
Hoppe-Lotichius
Maria
M
Tripkovic
Vuk
V
Barreiros
Ana P
AP
Wehler
Thomas C
TC
Zimmermann
Anca
A
Schattenberg
Jörn M
JM
Heise
Michael
M
Biesterfeld
Stefan
S
Galle
Peter R
PR
Otto
Gerd
G
Schuchmann
Marcus
M
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
D007166:Immunosuppressive Agents; D013256:Steroids