title: Human leukocyte antigen type and posttransplant lymphoproliferative disorder.
abstract: BACKGROUND
  Posttransplant lymphoproliferative disorder (PTLD) is an infrequent but serious complication of solid organ transplantation. Early detection and initiation of therapy may improve outcomes. The purpose of this study was to identify human leukocyte antigen (HLA) type as risk and prognostic factors for PTLD.
  
  
  METHODS
  A review was undertaken to identify PTLD cases treated at our institution over the past 25 years. Logistic regression and Cox Proportional Hazards were used to model risk factors for PTLD and clinical outcomes in patients with PTLD.
  
  
  RESULTS
  One hundred six cases of PTLD were identified with 1392 solid-organ transplant recipient controls. Epstein-Barr virus (EBV) seronegative status pretransplant (odds ratio [OR] = 7.61, 95% confidence interval [95% CI] = 3.83-15.1) and receipt of a nonkidney transplant were associated with an increased risk of PTLD. Being African American and receipt of a living-related kidney transplant were associated with a decreased risk of PTLD. The HLA-B40 group was a risk factor for PTLD in EBV-seronegative individuals (OR = 8.38, 95% CI = 2.18-32.3), whereas HLA-B8 was a risk factor for PTLD in EBV-seropositive individuals (OR = 3.29, 95% CI = 1.52-7.09). Specific HLA types were not associated with graft failure or mortality after PTLD diagnosis. In PTLD patients, central nervous system (CNS) involvement, bone marrow involvement, T-cell PTLD, and age were associated with increased mortality.
  
  
  CONCLUSIONS
  Human leukocyte antigen-B40 group and HLA-B8 were identified as novel susceptibility factors for PTLD in EBV-seropositive and EBV-seronegative individuals, respectively. Multicentered, large prospective studies of PTLD with correlative immunologic work are needed to test the significance of these observed associations.
authors.affiliation: 1 Division of Infectious Diseases, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH. 2 Division of Transplantation Surgery, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH. 3 Division of Hematology, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH. 4 The Ohio State University Comprehensive Cancer Center, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, OH.
authors.forename: Mark E
authors.initials: ME
authors.lastname: Lustberg
authors.forename: Ronald P
authors.initials: RP
authors.lastname: Pelletier
authors.forename: Pierluigi
authors.initials: P
authors.lastname: Porcu
authors.forename: Stanley I
authors.initials: SI
authors.lastname: Martin
authors.forename: Carl D
authors.initials: CD
authors.lastname: Quinion
authors.forename: Susan M
authors.initials: SM
authors.lastname: Geyer
authors.forename: Michael A
authors.initials: MA
authors.lastname: Caligiuri
authors.forename: Robert A
authors.initials: RA
authors.lastname: Baiocchi
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D015331:Cohort Studies; D004198:Disease Susceptibility; D020031:Epstein-Barr Virus Infections / Q000150:complications / Q000276:immunology; D005260:Female; D006680:HLA Antigens; D059947:HLA-B40 Antigen; D015795:HLA-B8 Antigen; D006650:Histocompatibility Testing; D006801:Humans; D053208:Kaplan-Meier Estimate; D008232:Lymphoproliferative Disorders / Q000209:etiology* / Q000276:immunology* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009820:Ohio / Q000453:epidemiology; D016377:Organ Transplantation / Q000009:adverse effects* / Q000401:mortality; D011183:Postoperative Complications / Q000209:etiology* / Q000276:immunology* / Q000401:mortality; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D006680:HLA Antigens; D059947:HLA-B40 Antigen; D015795:HLA-B8 Antigen