title: Post-transplant lymphoproliferative disorder after liver transplantation: Incidence, long-term survival and impact of serum tacrolimus level.
abstract: OBJECTIVE
  To investigate incidence and survival of post-transplant lymphoproliferative disorder (PTLD) patients after liver transplantation.
  
  
  METHODS
  A cross-sectional survey was conducted among patients who underwent liver transplantation at Shiraz Transplant Center (Shiraz, Iran) between August 2004 and March 2015. Clinical and laboratory data of patients were collected using a data gathering form.
  
  
  RESULTS
  There were 40 cases of PTLD in the pediatric age group and 13 cases in the adult group. The incidence of PTLD was 6.25% in pediatric patients and 1.18% in adult liver transplant recipients. The post-PTLD survival of patients at 6 mo was 75.1% ± 6%, at 1 year was 68.9% ± 6.5% and at 5 years was 39.2% ± 14.2%. Higher serum tacrolimus level was associated with lower post-PTLD survival in pediatric patients (OR = 1.07, 95%CI: 1.006-1.15,P= 0.032). A serum tacrolimus level over 11.1 ng/mL was predictive of post PTLD survival (sensitivity = 90%, specificity = 52%, area under the curve = 0.738,P= 0.035).
  
  
  CONCLUSIONS
  Incidence of PTLD in our liver transplant patients is comparable to other centers. Transplant physicians may consider adjustment of tacrolimus dose to maintain its serum level below this cutoff point.
authors.affiliation: Ahad Eshraghian, Mohammad Hadi Imanieh, Seyed Mohsen Dehghani, Saman Nikeghbalian, Alireza Shamsaeefar, Kourosh Kazemi, Bita Geramizadeh, Seyed Ali Malek-Hosseini, Transplant Research Center, Shiraz University of Medical Sciences, Shiraz 71937-11351, Iran.
authors.forename: Ahad
authors.initials: A
authors.lastname: Eshraghian
authors.affiliation: Ahad Eshraghian, Mohammad Hadi Imanieh, Seyed Mohsen Dehghani, Saman Nikeghbalian, Alireza Shamsaeefar, Kourosh Kazemi, Bita Geramizadeh, Seyed Ali Malek-Hosseini, Transplant Research Center, Shiraz University of Medical Sciences, Shiraz 71937-11351, Iran.
authors.forename: Mohammad Hadi
authors.initials: MH
authors.lastname: Imanieh
authors.affiliation: Ahad Eshraghian, Mohammad Hadi Imanieh, Seyed Mohsen Dehghani, Saman Nikeghbalian, Alireza Shamsaeefar, Kourosh Kazemi, Bita Geramizadeh, Seyed Ali Malek-Hosseini, Transplant Research Center, Shiraz University of Medical Sciences, Shiraz 71937-11351, Iran.
authors.forename: Seyed Mohsen
authors.initials: SM
authors.lastname: Dehghani
authors.affiliation: Ahad Eshraghian, Mohammad Hadi Imanieh, Seyed Mohsen Dehghani, Saman Nikeghbalian, Alireza Shamsaeefar, Kourosh Kazemi, Bita Geramizadeh, Seyed Ali Malek-Hosseini, Transplant Research Center, Shiraz University of Medical Sciences, Shiraz 71937-11351, Iran.
authors.forename: Saman
authors.initials: S
authors.lastname: Nikeghbalian
authors.affiliation: Ahad Eshraghian, Mohammad Hadi Imanieh, Seyed Mohsen Dehghani, Saman Nikeghbalian, Alireza Shamsaeefar, Kourosh Kazemi, Bita Geramizadeh, Seyed Ali Malek-Hosseini, Transplant Research Center, Shiraz University of Medical Sciences, Shiraz 71937-11351, Iran.
authors.forename: Alireza
authors.initials: A
authors.lastname: Shamsaeefar
authors.affiliation: Ahad Eshraghian, Mohammad Hadi Imanieh, Seyed Mohsen Dehghani, Saman Nikeghbalian, Alireza Shamsaeefar, Kourosh Kazemi, Bita Geramizadeh, Seyed Ali Malek-Hosseini, Transplant Research Center, Shiraz University of Medical Sciences, Shiraz 71937-11351, Iran.
authors.forename: Frouzan
authors.initials: F
authors.lastname: Barshans
authors.affiliation: Ahad Eshraghian, Mohammad Hadi Imanieh, Seyed Mohsen Dehghani, Saman Nikeghbalian, Alireza Shamsaeefar, Kourosh Kazemi, Bita Geramizadeh, Seyed Ali Malek-Hosseini, Transplant Research Center, Shiraz University of Medical Sciences, Shiraz 71937-11351, Iran.
authors.forename: Kourosh
authors.initials: K
authors.lastname: Kazemi
authors.affiliation: Ahad Eshraghian, Mohammad Hadi Imanieh, Seyed Mohsen Dehghani, Saman Nikeghbalian, Alireza Shamsaeefar, Kourosh Kazemi, Bita Geramizadeh, Seyed Ali Malek-Hosseini, Transplant Research Center, Shiraz University of Medical Sciences, Shiraz 71937-11351, Iran.
authors.forename: Bita
authors.initials: B
authors.lastname: Geramizadeh
authors.affiliation: Ahad Eshraghian, Mohammad Hadi Imanieh, Seyed Mohsen Dehghani, Saman Nikeghbalian, Alireza Shamsaeefar, Kourosh Kazemi, Bita Geramizadeh, Seyed Ali Malek-Hosseini, Transplant Research Center, Shiraz University of Medical Sciences, Shiraz 71937-11351, Iran.
authors.forename: Seyed Ali
authors.initials: SA
authors.lastname: Malek-Hosseini
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D015994:Incidence; D007492:Iran; D053208:Kaplan-Meier Estimate; D017093:Liver Failure / Q000601:surgery*; D016031:Liver Transplantation / Q000009:adverse effects*; D008232:Lymphoproliferative Disorders / Q000453:epidemiology / Q000209:etiology*; D008297:Male; D011183:Postoperative Complications; D012044:Regression Analysis; D012307:Risk Factors; D012680:Sensitivity and Specificity; D016559:Tacrolimus / Q000097:blood*; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents; D016559:Tacrolimus
keywords: Epstein-Barr virus; Liver transplantation; Post-transplant lymphoproliferative disorder; Survival; Tacrolimus