Clinical lung and heart/lung transplantationLymphoproliferative disease after lung transplantation: comparison of presentation and outcome of early and late cases☆
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Patients
All patients who underwent lung or heart–lung transplantation at Barnes–Jewish Hospital, a tertiary care affiliate of Washington University School of Medicine, St Louis, MO, between July 1, 1988 and January 1, 2000, were included in this study. The assessment of outcomes was continued through April 15, 2000, the end of the study period.
PTLD was diagnosed in 30 of 494 recipients. For reference in this study, the cases of PTLD were serially numbered in chronologic order according to the
Diagnosis, classification and management of PTLD
Throughout the study period, evaluation of clinically apparent abnormalities led to the detection of PTLD. The diagnosis was confirmed by biopsy or surgical excision (n = 26), fine needle aspiration (n = 2) or autopsy (n = 2). One of the cases that was initially diagnosed by needle aspiration was subsequently corroborated by post-mortem pathology. The date of confirmation was used as the date of diagnosis in the analyses.
A pathologist (M.D.K.) who was blinded to the clinical information
Data analysis
The date of transplantation, date of death or last follow-up, cause of death, site(s) of PTLD, treatment for PTLD and response to treatment were recorded. Age at transplantation and age at PTLD diagnosis were calculated. For statistical analysis, cases were classified according to the time of onset and the site(s) of PTLD and were analyzed in several ways: “Early” vs “Late”; “Thoracic” (any site in chest, with or without an extrathoracic site) vs “Extrathoracic” (sites exclusively outside
Results
Between July 1, 1988 and January 1, 2000, 494 adult patients underwent lung (n = 491) or heart–lung (n = 3) transplantation at Barnes–Jewish Hospital (Table I). Kaplan–Meier survival rates for these recipients were 84% at 1 year, 70% at 3 years and 52% at 5 years after transplantation. The mean (±SD) duration of observation for the recipients was 3.4 ± 2.6 years (median 2.8 years), and the study included 1687 patient-years of follow-up. Three hundred eighty-four recipients had follow-up beyond
Discussion
Post-transplantation lymphoproliferative disease has become a well-known complication of lung transplantation, but it has not been characterized completely. A synopsis of the published series of PTLD after lung transplantation is presented in Table IV. Most studies have reported small cohorts of recipients that have been monitored for a relatively short time after transplantation. Although the follow-up period has varied and has not always been clearly specified, the incidence of PTLD in these
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Supported by the National Heart, Lung and Blood Institute; National Institutes of Health (Grant K23 HL04236) (Dr Yusen); and by the Rosemary and I. Jerome Flance Professorship in Pulmonary Medicine (Dr. Trulock).