Experience with 274 cardiac transplant recipients with posttransplant lymphoproliferative disorder: a report from the Israel Penn International Transplant Tumor Registry

TitleExperience with 274 cardiac transplant recipients with posttransplant lymphoproliferative disorder: a report from the Israel Penn International Transplant Tumor Registry
Publication TypeJournal Article
Year of Publication2004
AuthorsAull MJ, Buell JF, Trofe J, First MR, Alloway RR, Hanaway MJ, Wagoner L, Gross TG, Beebe T, Woodle ES
JournalTransplantation
Volume78
Issue11
Pagination1676 - 82
Date PublishedDec 15
Accession Number15591959
KeywordsAdult, Aged, Female, Heart Transplantation / *adverse effects / mortality, Humans, Immunosuppression, Lymphoproliferative Disorders / *etiology / therapy, Male, Middle Aged, Registries
Abstract

BACKGROUND: Posttransplant lymphoproliferative disorder (PTLD) is a life-threatening complication that occurs in a small but significant minority of solid organ transplant recipients. Published experiences with PTLD in cardiac transplant recipients are limited to relatively small single-center reports. METHODS: This report presents experience with 274 cases of PTLD in cardiac transplant recipients reported to the Israel Penn International Transplant Tumor Registry (IPITTR). RESULTS: PTLD carried an ominous prognosis: Kaplan Meier survival after PTLD diagnosis was 45%, 33%, 30%, and 13%, respectively, at 1, 3, 5, and 10 years. Common causes of death included: PTLD, cardiovascular collapse, and infection; all occurred at a median of less than 6 months. Risk of death from cardiovascular collapse secondary to immunosuppression withdrawal was substantial (28%), indicating that a fine balance exists between death from PTLD and from sudden cardiac death due to acute rejection. PTLD therapy in the majority of patients consisted of combination therapy (49%). Survival in patients receiving immunosuppression minimization (ISM) alone was 32%, with ISM plus other therapy was 27%, and with other therapies not containing ISM was 11% (P

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