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Incidence and outcomes of post‐transplant lymphoproliferative disease after 5365 solid‐organ transplants over a 20‐year period at two UK transplant centres
journal contribution
posted on 2023-07-26, 15:44 authored by Anna Santarsieri, John F. Rudge, Irum Amin, Will Gelson, Jasvir Parmar, Stephen Pettit, Lisa Sharkey, Benjamin J. Uttenthal, George FollowsPost-transplant lymphoproliferative disease (PTLD) is a life-threatening complication of solid-organ transplantation (SOT). We present the incidence and outcomes of PTLD in a cohort of 5365 SOT recipients over a 20-year period at two UK transplant centres. With a median follow-up of 7.7 years, 142 of 5365 patients have developed PTLD. Cumulative incidence was 18% at five years after multivisceral transplant and 1%–3% at five years following the other SOT types. Twenty-year cumulative incidence was 2%–3% following liver and heart transplantation and 10% following kidney transplantation. Median overall survival (OS) following SOT was 16 years, which is significantly reduced compared with the age-adjusted UK population. There is relatively high early mortality following diagnosis of PTLD and only patients surviving two years regained a longer-term survival approaching the non-PTLD SOT cohort. Of 90 patients with monomorphic PTLD, diffuse large B-cell lymphoma, 66 were treated with first-line rituximab monotherapy and 24 received first-line rituximab plus chemotherapy. Up-front rituximab monotherapy does not appear to compromise OS, but the number of patients dying from non-lymphoma causes before and after treatment remains high with both treatment approaches. Multivariate analysis of all 90 monomorphic PTLD patients identified an International Prognostic Index (IPI) of 3+ as the strongest pretreatment variable associating with inferior one-year OS.
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Refereed
- Yes
Volume
197Issue number
3Page range
310-319Publication title
British Journal of HaematologyISSN
1365-2141External DOI
Publisher
WileyLanguage
- other
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2022-03-21Legacy Faculty/School/Department
Faculty of Health, Education, Medicine & Social CareUsage metrics
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