title: Post-transplant lymphoproliferative disorder in liver recipients: Characteristics, management, and outcome from a single-centre experience with >1000 liver transplantations.
abstract: BACKGROUND
  The literature regarding post-transplant lymphoproliferative disorder (PTLD) in liver transplant recipients (LTRs) is limited.
  
  
  OBJECTIVE
  To study the incidence, predictors and outcomes of PTLD after liver transplantation in a single, large-volume centre.
  
  
  METHODS
  The charts of all LTRs (n=1372) in the authors' centre between January 2000 and June 2012 were retrospectively reviewed and those who developed PTLD were identified. Demographic, clinical and treatment data were prospectively collected. Responses to treatment, including complete response, no response, relapse and survival, were recorded.
  
  
  RESULTS
  The incidence of PTLD in LTRs was 32 in 1372 (2.3%). Overall, median survival was 37 months (range 0.5 to 195 months), with one-, three- and five-year survival rates of 81%, 74% and 60%, respectively. Epstein-Barr virus (EBV)-negative patients had a better mean (± SD) survival (95±79 months) than EBV-positive patients (41±42 months) (P=0.02). For stage I⁄II PTLD, one-, three- and five-year actuarial survival was 87%, 87% and 75%, compared with 50%, 30% and 0% for stage III⁄IV PTLD, respectively (P=0.001). In patients with complete response, median survival was 58 months (range 10 to 195 months); and one-, three- and five-year actuarial survival was 100%, 94% and 76%, respectively, after diagnosis of PTLD. Changing immunosuppression (IS) from calcineurin inhibitor to sirolimus at the time of diagnosis may have improved survival (seven of seven survivors) compared with only decreasing or stopping IS (14 of 25 survivors) (P=0.07).
  
  
  CONCLUSIONS
  This series from a single large-volume centre showed excellent short and long-term survival after PTLD in adult LTRs who were EBV negative, had early disease and showed complete response. Consistent with the known in vitro antiproliferative effect of sirolimus, switching IS from calcineurin inhibitor to sirolimus may improve survival.
authors.forename: Khalid
authors.initials: K
authors.lastname: Mumtaz
authors.forename: Nabiha
authors.initials: N
authors.lastname: Faisal
authors.forename: Max
authors.initials: M
authors.lastname: Marquez
authors.forename: Alicia
authors.initials: A
authors.lastname: Healey
authors.forename: Leslie B
authors.initials: LB
authors.lastname: Lilly
authors.forename: Eberhard L
authors.initials: EL
authors.lastname: Renner
mesh_terms: D000328:Adult; D000368:Aged; D058846:Antibodies, Monoclonal, Murine-Derived / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D065095:Calcineurin Inhibitors / Q000009:adverse effects / Q000627:therapeutic use; D059248:Chemoradiotherapy; D003520:Cyclophosphamide / Q000627:therapeutic use; D016208:Databases, Factual; D004317:Doxorubicin / Q000627:therapeutic use; D020031:Epstein-Barr Virus Infections / Q000139:chemically induced / Q000453:epidemiology; D005260:Female; D006084:Graft Rejection / Q000517:prevention & control; D006689:Hodgkin Disease / Q000139:chemically induced / Q000453:epidemiology / Q000628:therapy; D061847:Hospitals, High-Volume; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use; D015994:Incidence; D016031:Liver Transplantation; D016403:Lymphoma, Large B-Cell, Diffuse / Q000139:chemically induced / Q000453:epidemiology / Q000628:therapy; D008228:Lymphoma, Non-Hodgkin / Q000139:chemically induced / Q000453:epidemiology / Q000628:therapy; D008232:Lymphoproliferative Disorders / Q000139:chemically induced / Q000453:epidemiology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000139:chemically induced / Q000453:epidemiology / Q000628:therapy*; D011241:Prednisone / Q000627:therapeutic use; D012189:Retrospective Studies; D000069283:Rituximab / Q000627:therapeutic use*; D020123:Sirolimus / Q000009:adverse effects / Q000627:therapeutic use; D014750:Vincristine / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D065095:Calcineurin Inhibitors; D007166:Immunosuppressive Agents; C571759:R-CHOP protocol; D000069283:Rituximab; D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D011241:Prednisone; D020123:Sirolimus