A systematic review of post-transplant lymphoproliferative disorder after lung transplant.

e19046 Background: Post-transplant lymphoproliferative disorder (PTLD) is a serious complication after solid organ transplantation. This study aims to explore the association of PTLD diagnosed after lung transplant with infectious agents and immunosuppression regimen, explore types of PTLD, and their outcome. Methods: Following the PRISMA guideline, we searched the literature on PubMed, Cochrane, Embase, and clinicaltrials.gov. 1741 articles were screened and included five studies. Results: We analyzed data from five studies, n=13,643 transplant recipients with n=287 (2.10%) developed PTLD. Four studies showed that 32/63 (51%) PTLD patients were male and 31 (49%) were female. Three studies reported 53/55 (96.4%) patients were EBV positive at PTLD diagnosis. Courtwright. et al, reported that 217/224 (97%) PTLD was associated with either EBV positive donor or recipient. Four studies showed that the monomorphic B cell type 48/63 (76%) was the most common histological type of PTLD diagnosed with DLBCL the most common subtype 31/48 (64.6%). Data from 3 studies showed that the onset of PTLD following lung transplant varies with a median duration of 18.3 months (45 days to 20.2 years). Three studies showed that 26/55 (47.3%) patients had early-onset (≤ 1 yr of Tx) and 29/55 (52.7%) patients had late-onset PTLD (> 1 yr of Tx). Management of PTLD included a reduction in immunosuppression including corticosteroids, CNI, purine synthesis inhibitors, Rituximab, and chemotherapeutic agents. Three studies showed a mortality rate of 30/45 (66.7%) and 13/30 (43.3%) deaths were PTLD related. Conclusions: Our review concludes that PTLD is a serious complication, only 2% of lung transplant recipients developed PTLD. EBV seropositivity is the most factor associated with PTLD diagnosis. Monomorphic PTLD was reported as the most common type in the adult population and no association between gender and PTLD was found. The analysis shows that there is a slightly lower incidence of early (≤ 1 yr of Tx) than late-onset (> 1 yr of Tx) PTLD. Table 1 PTLD after a Lung transplant in adults - a review. [Table: see text]

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Use of Foscarnet Therapy for EBV Infection following Control of PTLD with Enhancement of Cellular Immunity in a Lung-Transplant Recipient

Journal of Transplantation ◽

10.1155/2011/919651 ◽

2011 ◽

Vol 2011 ◽

pp. 1-4 ◽

Cited By ~ 3

Author(s):

Kamyar Afshar ◽

A. Purush Rao ◽

Vipul Patel ◽

Kevin Forrester ◽

Sivagini Ganesh

Keyword(s):

Lymphoproliferative Disorder ◽

Lung Transplant ◽

Strong Association ◽

Solid Organ Transplantation ◽

Solid Organ ◽

Transplant Recipients ◽

Posttransplant Lymphoproliferative Disorder ◽

Annual Incidence Rate ◽

Ebv Infection ◽

Lung Transplant Recipients

Posttransplant lymphoproliferative disorder (PTLD) is a serious complication following solid organ transplantation with an annual incidence rate of 3–5% in lung-transplant recipients. Pathogenesis indicates a strong association with functional over-immunosuppression and EBV infection. Clinical improvement is generally observed with reduction in immunosuppression intensity alone. We present a case of a 24-year-old woman with EBV-associated PTLD following lung transplant where decreasing the immunosuppression improved PTLD but was ineffective against controlling the EBV infection. Foscarnet in combination with immunoglobulins was successfully administered to cause a remission of the EBV infection. This is the second case reported of a persistent EBV infection after reducing immunosuppression levels and evidence of PTLD remission that required foscarnet for EBV infection control.

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Evidence of Epstein‐Barr virus heterogeneous gene expression in adult lung transplant recipients with post‐transplant lymphoproliferative disorder

Journal of Medical Virology ◽

10.1002/jmv.26936 ◽

2021 ◽

Author(s):

Lorenzo Zaffiri ◽

Courtney Frankel ◽

Erika J Bush ◽

Megan L Neely ◽

Elizabeth N Pavlisko ◽

...

Keyword(s):

Gene Expression ◽

Lymphoproliferative Disorder ◽

Lung Transplant ◽

Epstein Barr Virus ◽

Transplant Recipients ◽

Post Transplant ◽

Adult Lung ◽

Barr Virus ◽

Epstein Barr ◽

Lung Transplant Recipients

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Identification of Epstein-Barr Virus Related Risk Factors for the Occurrence of Post-Transplant Lymphoproliferative Disorder in Lung Transplant Recipients

The Journal of Heart and Lung Transplantation ◽

10.1016/j.healun.2021.01.1904 ◽

2021 ◽

Vol 40 (4) ◽

pp. S67

Author(s):

B.J. Pierce ◽

E. Allen ◽

C. Pham ◽

D.T. Nguyen ◽

E.A. Graviss ◽

...

Keyword(s):

Risk Factors ◽

Lymphoproliferative Disorder ◽

Lung Transplant ◽

Epstein Barr Virus ◽

Transplant Recipients ◽

Post Transplant ◽

Barr Virus ◽

Related Risk ◽

Epstein Barr ◽

Lung Transplant Recipients

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Positron Emission Tomography With Fluoro-2-deoxy-D-glucose (FDG-PET) in the Staging of Post Transplant Lymphoproliferative Disorder in Lung Transplant Recipients

Journal of Thoracic Imaging ◽

10.1097/00005382-200404000-00002 ◽

2004 ◽

Vol 19 (2) ◽

pp. 74-78 ◽

Cited By ~ 35

Author(s):

Edith M Marom ◽

H Page McAdams ◽

Kelly J Butnor ◽

R Edward Coleman

Keyword(s):

Positron Emission Tomography ◽

Fdg Pet ◽

Lymphoproliferative Disorder ◽

Lung Transplant ◽

Emission Tomography ◽

Transplant Recipients ◽

Post Transplant ◽

Positron Emission ◽

Lung Transplant Recipients

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1103. Improving Perioperative Prophylactic Antimicrobial Guideline Concordance in Liver and Lung Transplant Recipients

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.967 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S391-S392

Author(s):

Cynthia T Nguyen ◽

Rachel Marrs ◽

Jennifer Pisano ◽

Natasha N Pettit ◽

Lisa Potter

Keyword(s):

Antimicrobial Stewardship ◽

Lung Transplant ◽

Small Sample Size ◽

Solid Organ Transplantation ◽

Composite Endpoint ◽

Small Sample ◽

Solid Organ ◽

Transplant Recipients ◽

Modifiable Factor ◽

Lung Transplant Recipients

Abstract Background Surgical site infection (SSI) is a common complication among patients undergoing solid-organ transplantation. Administration of perioperative antimicrobials is one modifiable factor that may reduce the risk of SSIs. We sought to evaluate antimicrobial stewardship efforts to improve concordance of perioperative antimicrobial selection (AS) and dose timing (DT) with the institution’s perioperative antimicrobial guidelines among liver (LVR) and lung transplant recipients (LNG). Methods This was a single-center, observational study of LVR and LNG between January 1, 2017 and December 31, 2018. Patients receiving antimicrobials for the treatment of infection immediately prior to transplant were excluded. Throughout the study period, several interventions were performed, including: updating AS and DT protocols (2017 Q2) and preoperative order sets (2017 Q4), improving availability of antibiotics in the operating room (2018 Q1), and most recently developing a guideline and providing education for intraoperative redosing based on renal function (2018 Q3). The primary outcome was overall guideline concordance (GC). This was a composite endpoint including preoperative and intraoperative AS and DT, based on the institution’s guideline. Secondary outcomes included SSI rates based on the CDC National Healthcare Safety Network definition and rate of new C. difficile or vancomycin-resistant Enterococci infection or colonization. Results Among 112 patient screened, 79 patients were included (45 LNG and 34 LVR). The median age was 60 years and BMI was 26.5 kg/m2. The median procedure length was 7.8 hours for LNG and 6.9 hours for LVR. Results are shown in Table 1, Figure 1 and Figure 2. All GC rates demonstrate improvements over time, except for intraoperative DT for LNG. Conclusion Limited by a small sample size, our study demonstrates that noninvasive antimicrobial stewardship strategies can yield improvements in GC. Disclosures All authors: No reported disclosures.

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Post-Transplant Lymphoproliferative Disorder in Lung Transplant Recipients – a Shift Lo Late Onset Disease

Blood ◽

10.1182/blood.v120.21.5075.5075 ◽

2012 ◽

Vol 120 (21) ◽

pp. 5075-5075

Author(s):

Eli Muchtar ◽

Liat Vidal ◽

Ron Ram ◽

Ronit Gurion ◽

Yivgenia Rosenblat ◽

...

Keyword(s):

Complete Remission ◽

Disease Progression ◽

Median Time ◽

Early Onset ◽

Lymphoproliferative Disorder ◽

Lung Transplant ◽

Late Onset ◽

Transplant Recipients ◽

Lung Transplant Recipients

Abstract Abstract 5075 Background: Post-transplant lymphoproliferative disorder (PTLD) is a well-recognized complication after solid organ transplantation. Most cases of PTLD arise within the first year from transplantation and are associated with EBV infection. However, there are increasing reports on a late onset form of PTLD. Methods: We reviewed all charts of patients undergoing either lung or heart-lung transplantation in a tertiary center in Israel between the years 1997 and 2012. PTLD was defined according to the WHO criteria. We analyzed baseline characteristics, clinical and pathological parameters as well as transplantation outcomes. Results: We identified 9 PTLD patients among cohort of 336 lung and heart-lung transplant recipients (incidence=2. 7%). Additional PTLD patient from another hospital was added for the clinical analysis (10 patients overall). Median age at transplantation of the PTLD patients was 50 (range 11–63) years, compared to 56 (2–69) among the non-PTLD patients (p=0. 04). Idiopathic pulmonary fibrosis was the leading etiology for transplantation among both PTLD and non-PTLD patients (50% vs. 37. 2%, respectively, p=0. 5), while relatively less COPD patients were observed among PTLD patients (10% vs. 34%, respectively, p=0. 28). Median time from transplantation to PTLD diagnosis was 41 (range 3–128) months, being among the longest to be reported in the literature among lung transplant recipients. Three patients developed early PTLD in our cohort, all were pre-transplant EBV seronegative and all were asymptomatic, diagnosed during surveillance chest imaging. In contrast, the seven late-onset PTLD cases were all EBV seropositive prior to transplantation, and were diagnosed after presenting with various symptoms, mainly B symptoms (71%). Overall extra-nodal involvement at presentation was very common for both PTLD forms (90%). While early onset PTLD uniformly involved the transplanted lung, this was relatively rare in the late-PTLD (100% vs. 14%, p=0. 03). According to the WHO classification, all PTLD specimens were monoclonal, based on molecular or light chain immuno-histochemistry. Eight (80%) cases were CD20 positive B cell lymphomas. EBV staining in the specimens was positive in 7 patients, including the 3 early-onset PTLD cases. All patients were treated with reduction of immunosuppression (Table). Other treatment modalities were diverse, including combination chemotherapy (6 patients), rituximab (6 patients), surgery (1 patient) and antiviral treatment (2 patients). 8 (80%) patients attained complete remission. With a median follow-up of 23 months, 6 patients died (3 from chronic rejection of the transplant, 1 from late chemotherapy toxicity, 1 from disease progression and 1 from unrelated cause). The median time from PTLD diagnosis to death was 19 months. Of the 8 patients attaining complete remission, only three patients are alive at the end of follow-up. Conclusion: Our cohort of lung transplant recipients demonstrates a trend of late-onset PTLD. This might be related to the high pre-transplant sero-prevalence to EBV in our cohort (96. 3%), as late-onset PTLD has been reported to be less associated with EBV proliferation. The majority of PTLD patients in our cohort died of treatment-related causes rather than disease progression. Disclosures: No relevant conflicts of interest to declare.

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Respiratory Viruses in Solid Organ Transplant Recipients

Viruses ◽

10.3390/v13112146 ◽

2021 ◽

Vol 13 (11) ◽

pp. 2146

Author(s):

Roni Bitterman ◽

Deepali Kumar

Keyword(s):

Lung Transplant ◽

Viral Infections ◽

Solid Organ Transplantation ◽

Clinical Manifestations ◽

Respiratory Viruses ◽

Solid Organ ◽

Transplant Recipients ◽

Increased Risk ◽

Respiratory Viral Infections ◽

Lung Transplant Recipients

Solid organ transplantation is often lifesaving, but does carry an increased risk of infection. Respiratory viral infections are one of the most prevalent infections, and are a cause of significant morbidity and mortality, especially among lung transplant recipients. There is also data to suggest an association with acute rejection and chronic lung allograft dysfunction in lung transplant recipients. Respiratory viral infections can appear at any time post-transplant and are usually acquired in the community. All respiratory viral infections share similar clinical manifestations and are all currently diagnosed using nucleic acid testing. Influenza has good treatment options and prevention strategies, although these are hampered by resistance to neuraminidase inhibitors and lower vaccine immunogenicity in the transplant population. Other respiratory viruses, unfortunately, have limited treatments and preventive methods. This review summarizes the epidemiology, clinical manifestations, therapies and preventive measures for clinically significant RNA and DNA respiratory viruses, with the exception of SARS-CoV-2. This area is fast evolving and hopefully the coming decades will bring us new antivirals, immunologic treatments and vaccines.

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