PRETRANSPLANTATION ASSESSMENT OF THE RISK OF LYMPHOPROLIFERATIVE DISORDER

Posttransplantation lymphoproliferative disorder (PTLD) is an uncommon but often fatal complication of solid organ transplantation that occu rs in similar to 3% of patients. To determine the relative importance and relationship of potential risk factors for PTLD before transplanta tion (i.e., Epstein-Barr virus [EBV] serostatus of the recipient and t he cytomegalovirus [CMV] serostatus of the recipient and the potential donor) and the principal risk factor after transplantation (immunosup pression with antilymphocyte antibody), we analyzed the findings for t he first 381 consecutive adult nonrenal transplant recipients seen at Mayo Clinic. In the absence of other risk factors, the incidence rate of PTLD for EBV-seronegative recipients was 24 times higher (95% confi dence interval [CI]: 6.2, 89) than that for EBV-seropositive recipient s. The additional risk factors of therapy with OKT3 for rejection and CMV seromismatch (i.e., a negative recipient and a positive donor) eac h further amplified this risk four- to sixfold. Together, all three ri sk factors acted synergistically to increase the incidence rate of fat al and/or CNS PTLD by a factor of 654 (CI: 368, 1,162) compared with t he low incidence rate (.458 cases per 100 person years) when none of t hese risk factors were present. Pretransplantation determination of re cipient EBV and CMV serostatus can identify a subgroup of patients who se risk for severe PTLD may preclude transplantation.