Abstract

BACKGROUND AND OBJECTIVES: the presentation time of post-transplantation lymphoproliferative disorders (PTLD) are not well described because of the limited number of cases occurring at each center and lack of a reliable and unequivocal classification together with the absence of multi-institutional prospective studies. We gathered information on the histopathological and clinical features and prognosis of the disease in a very large number of heart and lung transplant recipients, with data from 27 previous reports, with an emphasis of time of presentation. DESIGN AND SETTING: Retrospective analysis of data for individual patients from published studies, entered into a database and reanalyzed. METHODS: a comprehensive review of the literature by PubMed and Google Scholar was performed to find all data available reports on PTLD after heart and lung transplantation. RESULTS: Data from 288 PTLD patients after heart or lung transplantation from 27 reports were entered into analysis. Heart and lung recipients with early-onset PTLD compared with late-onset PTLD were significantly more likely to be of the b cell type (100 vs. 89.8, respectively; p=.05). PTLD in patients with early onset was less likely to involve the skin (p=.05) and spleen (p=.015), but more frequently complications of the respiratory tract (p=.002). morphology of PTLD lesions was significantly different between the two groups with a priority for late-onset PTLD to represent non-hodgkin lesions (p=.009). no difference was found between the two groups in survival (p=.237). One and five-year survival rates for early-onset PTLD patients were 65 and 46, respectively; compared to 53 and 41, respectively, for the late-onset PTLD. CONCLUSION: Due to a higher incidence of respiratory tract involvement in the early-onset PTLD patients and skin and spleen involvement in late-onset PTLD, we suggest that all heart/lung graft recipients should be evaluated for potential multiorgan disease based early or late presentation. further multi-institutional prospective studies are needed to confirm our results.