title: Posttransplant lymphoproliferative disease and survival in adult heart transplant recipients.
abstract: The influence of posttransplant lymphoproliferative disease (PTLD) on long-term survival after heart transplantation (HTx) in adult recipients needs better characterization.
  
  
  
  The United Network for Organ Sharing database was queried from 2006 to 2015 to compare survival between adult HTx recipients with and without PTLD. Cox proportional hazards models were used to analyze the primary outcome of survival, and competing-risks regression was used to analyze the outcome of PTLD development.
  
  
  
  A total of 14,487 HTx recipients who had data on PTLD were included in univariate Cox analysis and Kaplan-Meier survival function, while 10,422 were included in multivariable Cox analysis and 162 selected for a matched-pairs sample after matching on the propensity of developing PTLD. The cohort included 120 patients who were diagnosed with PTLD. Onset of PTLD, treated as a time-varying covariate, was adversely associated with survival in univariate (HR=4.953; 95% CI: 3.768, 6.511; p<0.001) and multivariable (HR=3.849; 95% CI: 2.669, 5.552; p<0.001) Cox proportional hazards models. Cox regression stratified on matched pairs of PTLD cases and non-PTLD controls confirmed the risk for death associated with PTLD onset (HR=2.667; 95% CI: 1.043, 6.815; p=0.040).
  
  
  
  PTLD onset negatively influenced survival in adult HTx recipients, whereas no characteristics predisposing patients to PTLD development were identified in multivariate analysis.
authors.affiliation: Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA; Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, OH, USA; Department of Surgery, The Ohio State University College of Medicine, Columbus, OH, USA; Division of Epidemiology, The Ohio State University College of Public Health, Columbus, OH, USA; Center for the Epidemiological Study of Organ Failure and Transplantation, Nationwide Children's Hospital and The Ohio State University, Columbus, OH, USA; Section of Pulmonary Medicine, Nationwide Children's Hospital, Columbus, OH, USA. Electronic address: hayes.705@osu.edu.
authors.forename: Don
authors.initials: D
authors.lastname: Hayes
authors.affiliation: Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA; Center for the Epidemiological Study of Organ Failure and Transplantation, Nationwide Children's Hospital and The Ohio State University, Columbus, OH, USA; Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA.
authors.forename: Dmitry
authors.initials: D
authors.lastname: Tumin
authors.affiliation: Division of Epidemiology, The Ohio State University College of Public Health, Columbus, OH, USA; Center for the Epidemiological Study of Organ Failure and Transplantation, Nationwide Children's Hospital and The Ohio State University, Columbus, OH, USA.
authors.forename: Randi E
authors.initials: RE
authors.lastname: Foraker
authors.affiliation: Center for the Epidemiological Study of Organ Failure and Transplantation, Nationwide Children's Hospital and The Ohio State University, Columbus, OH, USA; Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA; Department of Anesthesiology, The Ohio State University College of Medicine, Columbus, OH, USA.
authors.forename: Joseph D
authors.initials: JD
authors.lastname: Tobias
mesh_terms: D000328:Adult; D016208:Databases, Factual; D005260:Female; D016027:Heart Transplantation / Q000009:adverse effects* / Q000401:mortality*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008232:Lymphoproliferative Disorders / Q000209:etiology / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D057216:Propensity Score; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors
keywords: Adult; Heart transplantation; Posttransplant lymphoproliferative disease; Survival