A low incidence of posttransplant lymphoproliferative disorder in 109 lungtransplant recipients

Study objectives: The incidence of posttransplant lymphoproliferative disor der (PTLD) has been reported to range from 6.4 to 20% in lung transplant (L T) recipients. Postulated contributing factors include Epstein-Barr virus ( EBV) infection and the use of immunosuppression, particularly muromonab-CD3 (OKT3)(Orthoclone OKT-3; Ortho Biotech; Raritan, NJ). We sought to examine these PTLD risk factors in 109 LT recipients at our institution who surviv ed >1 month. Design: Retrospective review of EBV serology of all LT recipients at our in stitution. Our standard transplant protocol includes OKT3 for induction and refractory rejection, as well as lifelong acyclovir for herpes prophylaxis , We do not perform EBV donor-recipient matching. Setting: A university-based LT center. Results: We found that 5 of 109 patients were serologically negative for EB V prior to lung transplantation, and all of these patients converted follow ing lung transplantation, The mean time to conversion was 151 days (range, 11 to 365 days). One fatal case of PTLD was documented in an EBV seroconver ter (one of five patients) 12 weeks status posttransplantation for lymphang ioleiomyomatosis. One nonfatal extrathoracic PTLD was documented in a serop ositive patient (1 of 104 patients) 33 months posttransplantation. Conclusions: We conclude the following: (1) PTLD in LT recipients may have a lower incidence (2 of 109 patients; 1.8%) than previously reported, despi te an aggressive immunosuppressive regimen; and (2) the incidence of PTLD i s higher in patients with primary EBV infection (20% vs 1%).