Retrospective Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Feb 21, 2017; 23(7): 1224-1232
Published online Feb 21, 2017. doi: 10.3748/wjg.v23.i7.1224
Post-transplant lymphoproliferative disorder after liver transplantation: Incidence, long-term survival and impact of serum tacrolimus level
Ahad Eshraghian, Mohammad Hadi Imanieh, Seyed Mohsen Dehghani, Saman Nikeghbalian, Alireza Shamsaeefar, Frouzan Barshans, Kourosh Kazemi, Bita Geramizadeh, Seyed Ali Malek-Hosseini
Ahad Eshraghian, Mohammad Hadi Imanieh, Seyed Mohsen Dehghani, Saman Nikeghbalian, Alireza Shamsaeefar, Kourosh Kazemi, Bita Geramizadeh, Seyed Ali Malek-Hosseini, Transplant Research Center, Shiraz University of Medical Sciences, Shiraz 71937-11351, Iran
Ahad Eshraghian, Mohammad Hadi Imanieh, Seyed Mohsen Dehghani, Frouzan Barshans, Gastroenterohepatology Research Center, Namazi Hospital, Shiraz 71937-11351, Iran
Author contributions: Eshraghian A and Imanieh MH contributed to the study concept and design; Eshraghian A, Imanieh MH and Barshans F drafted of the manuscript; Eshraghian A, Imanieh MH, Dehghani SM, Nikeghbalian S, Barshans F, Kazemi K and Malek-Hosseini SA contributed to acquisition, analysis and interpretation of data; Eshraghian A, Imanieh MH, Dehghani SM, Nikeghbalian S, Kazemi K and Malek-Hosseini SA also contributed to the patient care; Eshraghian A, Imanieh MH, Dehghani SM, Nikeghbalian S, Kazemi K, Geramizadeh B and Malek-Hosseini SA critically revised the manuscript for important intellectual content; and Geramizadeh B also contributed to the pathology review, acquisition of data; all the authors contributed to this manuscript.
Conflict-of-interest statement: The authors have no conflict of interest. The study was supported by a grant from Shiraz University of Medical Sciences.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Ahad Eshraghian, MD, Gastroenterohepatology Research Center, Namazi Hospital, Fars Province, Shiraz, District 1, Shiraz 71937-11351, Iran. eshraghiana@yahoo.com
Telephone: +98-71-36281442 Fax: +98-71-36281442
Received: September 19, 2016
Peer-review started: September 19, 2016
First decision: October 28, 2016
Revised: December 3, 2016
Accepted: January 18, 2017
Article in press: January 18, 2017
Published online: February 21, 2017
Processing time: 154 Days and 16.9 Hours
Abstract
AIM

To investigate incidence and survival of post-transplant lymphoproliferative disorder (PTLD) patients after liver transplantation.

METHODS

A cross-sectional survey was conducted among patients who underwent liver transplantation at Shiraz Transplant Center (Shiraz, Iran) between August 2004 and March 2015. Clinical and laboratory data of patients were collected using a data gathering form.

RESULTS

There were 40 cases of PTLD in the pediatric age group and 13 cases in the adult group. The incidence of PTLD was 6.25% in pediatric patients and 1.18% in adult liver transplant recipients. The post-PTLD survival of patients at 6 mo was 75.1% ± 6%, at 1 year was 68.9% ± 6.5% and at 5 years was 39.2% ± 14.2%. Higher serum tacrolimus level was associated with lower post-PTLD survival in pediatric patients (OR = 1.07, 95%CI: 1.006-1.15, P = 0.032). A serum tacrolimus level over 11.1 ng/mL was predictive of post PTLD survival (sensitivity = 90%, specificity = 52%, area under the curve = 0.738, P = 0.035).

CONCLUSION

Incidence of PTLD in our liver transplant patients is comparable to other centers. Transplant physicians may consider adjustment of tacrolimus dose to maintain its serum level below this cutoff point.

Keywords: Post-transplant lymphoproliferative disorder; Liver transplantation; Survival; Tacrolimus; Epstein-Barr virus

Core tip: Post-transplant lymphoproliferative disorder (PTLD) is one of the complications that may occur after liver transplantation. The present study is a survival analysis of liver transplant patients after PTLD development. The incidence of PTLD was 6.25% in pediatric patients and 1.18% in adult liver transplant recipients. The main new finding is association of serum tacrolimus level with post-PTLD survival. Higher serum tacrolimus level was associated with lower post-PTLD survival in pediatric patients.