title: Post-transplant lymphoproliferative disorder after lung transplantation: a review of 35 cases.
abstract: BACKGROUND
  Post-transplant lymphoproliferative disorder (PTLD) is a complication of organ transplantation. The risk of developing PTLD varies depending on a number of factors, including the organ transplanted and the degree of immunosuppression used.
  
  
  METHODS
  We report a retrospective analysis of 35 patients with PTLD treated at our center after lung transplantation. Of 705 patients who received allografts, 34 (4.8%) developed PTLD. One patient underwent transplantation elsewhere and was treated at our center.
  
  
  RESULTS
  PTLD involved the allograft in 49% of our patients and the gastrointestinal (GI) tract lumen in 23%. Histologically, 39% of tumors were monomorphic and 48% polymorphic. The time to presentation defined the location and histology of disease. Of 17 patients diagnosed within 11 months of transplantation, PTLD involved the allograft in 12 (71%) and the GI tract in 1 (p = 0.01). This "early" PTLD was 85% polymorphic (p = 0.006). Conversely, of the 18 patients diagnosed more than 11 months after transplant, the lung was involved in 5 (28%) and the GI tract in 7 (39%; p = 0.01). "Late" PTLD was 71% monomorphic (p = 0.006). Median overall survival after diagnosis was 18.57 months. Overall survival did not differ between all lung transplant recipients and those who developed PTLD.
  
  
  CONCLUSIONS
  PTLD is an uncommon complication after lung transplantation, and its incidence declined remarkably in the era of modern immunosuppression. We report several factors that are important for predisposition toward, progression of, and treatment of PTLD after lung transplantation.
authors: Abramson Cancer Center, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA, USA.
authors: Brandon E
authors: BE
authors: Kremer
authors: Ran
authors: R
authors: Reshef
authors: Jamal G
authors: JG
authors: Misleh
authors: Jason D
authors: JD
authors: Christie
authors: Vivek N
authors: VN
authors: Ahya
authors: Nancy P
authors: NP
authors: Blumenthal
authors: Robert M
authors: RM
authors: Kotloff
authors: Denis
authors: D
authors: Hadjiliadis
authors: Edward A
authors: EA
authors: Stadtmauer
authors: Stephen J
authors: SJ
authors: Schuster
authors: Donald E
authors: DE
authors: Tsai
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D041981:Gastrointestinal Tract / Q000473:pathology; D006801:Humans; D007165:Immunosuppression Therapy; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008168:Lung / Q000473:pathology; D016040:Lung Transplantation / Q000009:adverse effects* / Q000276:immunology* / Q000401:mortality; D008232:Lymphoproliferative Disorders / Q000453:epidemiology* / Q000401:mortality / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate