Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Feb;12(2):395-405.
doi: 10.1016/j.jchf.2023.10.018.

Temporal Trends, Risk Factors, and Clinical Outcomes of De Novo Lymphoproliferative Disorders After Heart Transplantation

In-Cheol Kim  1 , Sang Hyun Kim  2 , Jong-Chan Youn  3 , Darae Kim  4 , Seonhwa Lee  1 , Hyungseop Kim  1 , Jin-Jin Kim  2 , Mi-Hyang Jung  2 , Joseph W Rossano  5 , Wida S Cherikh  6 , Jon A Kobashigawa  7 , Josef Stehlik  8
Affiliations

Temporal Trends, Risk Factors, and Clinical Outcomes of De Novo Lymphoproliferative Disorders After Heart Transplantation

In-Cheol Kim et al. JACC Heart Fail. 2024 Feb.

Abstract

Background: Post-transplant lymphoproliferative disorder (PTLD) is an important cause of morbidity and mortality in heart transplant (HTx) recipients. However, previous studies of PTLD after HTx are limited to single-center analyses or extrapolated from all solid organ transplantations.

Objectives: The authors analyzed the temporal trends, risk factors, and clinical outcome of de novo PTLD specifically after HTx.

Methods: Using multi-institutional, multinational data from the International Society for Heart and Lung Transplantation Thoracic Organ Transplant Registry, the authors evaluated the real-world data of PTLD after HTx, transplanted between January 2000 and June 2015. Multivariable analysis was done to identify risk factors for PTLD development after HTx.

Results: Among 28,136 HTx recipients, 1,069 (3.8%) developed PTLD within 10 years of transplantation. PTLD showed a bimodal age pattern with peak incidence in patients of pediatric age and late adulthood at transplantation. The early transplant era (2000-2007 vs 2008-2015), male recipient, and EBV donor-positive-recipient-negative match were independent risk factors of PTLD development within 3 years of transplantation, whereas maintenance therapy with cyclosporine vs tacrolimus at initial discharge was associated with a lower incidence. PTLD development within 3 years of transplantation was significantly associated with mortality (HR: 2.42 [95% CI: 2.01-2.91]; P < 0.001). Survival after PTLD diagnosis was higher in the recent transplant era.

Conclusions: PTLD is relatively rare, but potentially fatal, post-transplant malignancy. PTLD incidence and mortality after HTx have decreased in the recent era. Strategies to minimize the risk of PTLD, and ensure early diagnosis and effective treatment are likely to improve outcomes in HTx.

Keywords: Ebstein-Barr virus; cyclosporine; heart transplant; lymphoproliferative disorder; post-transplant lymphoproliferative disorder.

PubMed Disclaimer

Conflict of interest statement

Funding Support and Author Disclosures This research was supported by the 2019 Transplant Registry Early Career Award Grant from the International Society for Heart and Lung Transplantation, by the National Research Foundation of Korea (NRF) grant funded by the Ministry of Science and ICT (NRF-2021R1F1A1063430), by the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health and Welfare, Republic of Korea (HI22C0198), by the Research Fund of Seoul St. Mary’s Hospital, Catholic University of Korea (2022), and by the Catholic Medical Center Research Foundation (2023). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Dr Rossano is a consultant for Merck, CRI Biotech, Bayer, and Bristol Myers Squibb. Dr Kobashigawa has received research grants from CareDx Inc, Sanofi-Genzyme, and CSL-Behringer. Dr Stehlik has received consulting fees from Natera, Medtronic and Sanofi Aventis. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Comment in

References

Publication types

LinkOut - more resources