Relationship of Post-Transplant Lymphoproliferative Disorders (PTLD) Subtypes and Clinical Outcome in Pediatric Heart Transplant Recipients: A Retrospective Single Institutional Analysis/Experience of 558 Patients

• Published in: Cancers Vol. 15; no. 3; p. 976
• Main Authors: Liu, Yan, Wang, Billy C, Zuppan, Craig W, Chau, Peter, Fitts, James, Chinnock, Richard, Wang, Jun
• Format: Journal Article
• Language: English
• Published: Switzerland MDPI AG 03-02-2023; MDPI
• Subjects: Age; Children; Classification; Diagnosis; Epstein-Barr virus; Heart; Heart transplantation; Heart transplants; Hodgkin's lymphoma; Hyperplasia; Immunoproliferative diseases; Immunosuppression; Infants; Infections; Lymphocytes; Lymphoma; Lymphoproliferative disorders; Mononucleosis; Patient outcomes; Patients; Pediatric research; Pediatrics; Posttransplant lymphoproliferative disorders; Risk factors; Statistical significance; Surgery; Survival; Transplantation; Tumors; United States; post-transplant; lymphoproliferative disorder; lymphoma; survival; EBV; heart transplant; CMV
• ISSN: 2072-6694; 2072-6694
• DOI: 10.3390/cancers15030976

Post-transplant lymphoproliferative disorders (PTLD) are heterogenous lymphoproliferative disorders that develop as a consequence of immunosuppression in transplant recipients. We sought to determine if subtypes of PTLD correlated with different outcomes. We performed a retrospective review of PTLD occurring in pediatric heart transplant recipients. A total of 558 children and infants underwent cardiac transplantation at our institution between 1985 and 2019 and were followed until March 2021. Forty-nine of 558 patients developed PTLD (8.8%). As compared to older children (>one year of age), infant recipients (<three months of age) were less likely to develop PTLD. Monomorphic PTLDs (M-PTLD, 61%) was the most common subtype at initial diagnosis, followed by non-destructive (21%), polymorphic (14%), and classic Hodgkin lymphoma (cHL, 4%). Patients who underwent transplantation at a young age (<three months) had significantly lower rates of M-PTLD or cHL and a longer time from transplant to PTLD diagnosis as compared to children older than one year at transplant (
= 0.04). Although not reaching statistical significance, patients with a shorter time to PTLD diagnosis showed a trend toward higher rates of M-PTLD or cHL. As expected, the overall survival (OS) of patients with M-PTLD or cHL was significantly lower than patients with non-destructive or polymorphic PTLD.