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A Low Incidence of Posttransplant Lymphoproliferative Disorder in 109 Lung Transplant Recipients^*

^* From the Department of Medicine (Drs. Levine, Angel, Anzueto, Susanto, Peters, and Bryan), Division of Pulmonary Diseases/Critical Care Medicine, and Department of Surgery (Dr. Sako), Division of Cardiothoracic Surgery and Transplant, University of Texas Health Science Center at San Antonio; and the South Texas Veterans Health Care System, Audie L. Murphy Memorial Veterans Hospital Division, San Antonio, TX

Correspondence to: Stephanie M. Levine, MD, FCCP, South Texas Veterans Health Care System, Audie L. Murphy Memorial Veterans Hospital Division, Pulmonary Section (111E), 7400 Merton Minter Blvd., San Antonio, TX 78284; e-mail: levines{at}uthscsa.edu

Study objectives: The incidence of posttransplant lymphoproliferative disorder (PTLD) has been reported to range from 6.4 to 20% in lung transplant (LT) recipients. Postulated contributing factors include Epstein-Barr virus (EBV) infection and the use of immunosuppression, particularly muromonab-CD3 (OKT3)(Orthoclone OKT-3; Ortho Biotech; Raritan, NJ). We sought to examine these PTLD risk factors in 109 LT recipients at our institution who survived > 1 month.

Design: Retrospective review of EBV serology of all LT recipients at our institution. Our standard transplant protocol includes OKT3 for induction and refractory rejection, as well as lifelong acyclovir for herpes prophylaxis. We do not perform EBV donor-recipient matching.

Setting: A university-based LT center.

Results: We found that 5 of 109 patients were serologically negative for EBV prior to lung transplantation, and all of these patients converted following lung transplantation. The mean time to conversion was 151 days (range, 11 to 365 days). One fatal case of PTLD was documented in an EBV seroconverter (one of five patients) 12 weeks status posttransplantation for lymphangioleiomyomatosis. One nonfatal extrathoracic PTLD was documented in a seropositive patient (1 of 104 patients) 33 months posttransplantation.

Conclusions: We conclude the following: (1) PTLD in LT recipients may have a lower incidence (2 of 109 patients; 1.8%) than previously reported, despite an aggressive immunosuppressive regimen; and (2) the incidence of PTLD is higher in patients with primary EBV infection (20% vs 1%).

Key Words: Epstein-Barr virus • lung transplantation • posttransplant lymphoproliferative disorder

This article has been cited by other articles:

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