ABSTRACT Background Post‐transplant lymphoproliferative disorder (PTLD) is the most common malignancy following solid organ transplants, affecting 1% to 4% of liver transplant recipients. Recent advancements have shifted the management of B‐cell PTLD, with rituximab (a monoclonal anti‐CD20 antibody) now used as the first‐line treatment, while chemotherapy is reserved for patients with inadequate responses. Reducing immunosuppression remains a key aspect of management but can lead to organ rejection and even necessitate re‐transplantation. Aims This study aimed to assess the prevalence, characteristics and outcomes of PTLD in Western Australian liver transplant recipients over 24 years. Methods We used hepatology and haematology databases to identify liver transplant recipients who developed PTLD from 1999 to 2023. Results Among 476 liver transplants, 16 patients developed PTLD, an incidence of 3.4%. PTLD occurred at a median of 66.5 months post‐transplant. Most cases were B‐cell lymphomas, CD20‐positive and associated with Epstein–Barr virus (EBV) infection. First‐line treatments included rituximab with chemotherapy ( n = 7) and rituximab monotherapy ( n = 5). The overall response rate was 69%, with 11 patients achieving complete remission at 6 months. One‐, three‐ and five‐year survival rates were 75%, 50% and 50%, respectively. Factors such as EBV load, lactate dehydrogenase levels and age did not significantly impact remission. Seven patients (44%) experienced graft rejection. Three patients underwent repeat transplant during the study period and remained alive at the conclusion of the study period. Conclusion Rituximab‐based treatments demonstrated promising outcomes, though graft rejection remains a challenge. Further research is needed to optimise treatment and reduce rejection risks in PTLD patients.
Reji et al. (Thu,) studied this question.