C47-17 Outcomes of Post-Transplant Lymphoproliferative Disorder Following Lung Transplantation: A High-Volume Single Center Experience

Rationale Post-transplant lymphoproliferative disorder (PTLD) remains a life-threatening complication for lung transplant (LT) recipients. The likelihood of developing PTLD is affected by several factors, including donor-recipient Epstein-Barr virus (EBV) serostatus, the primary pulmonary disease necessitating transplantation, and the intensity and type of immunosuppressive therapy administered. Methods We retrospectively reviewed all LTs performed at a single large-volume center from 2015 to 2024. Data included biopsy-proven PTLD, demographics, transplant factors (including EBV donor and recipient serostatus, induction agents), PTLD histology, locations, therapies, and outcomes. Results Out of 1,202 lung transplant recipients, 14 patients (1.2%) developed PTLD, comprising 21% double-lung and 79% single-lung transplant recipients. Underlying diseases included cystic fibrosis (7%), COPD (36%), ILD (21%), IPF (29%), and scleroderma-related fibrosis (7%). Roughly half received alemtuzumab induction, while the rest were given basiliximab. The average time to PTLD onset was 41 months, with early-onset cases (within one year) accounting for 21%. CD20 positivity was observed in 72% of cases, while 14% were negative and 14% indeterminate. Disease involved the allograft or intrathoracic sites in 50%, gastrointestinal and hepatic sites in 46%, and the central nervous system in 7%. Treatments included rituximab (21%), R-CHOP (36%), and velcade (7%), while 50% of patients did not receive therapy. The overall survival rate was 7% (1/14); among those who died (93%), 69% (9/13) died within one year of PTLD diagnosis, and the remaining 31% (4/13) survived an average of four years post-diagnosis. Conclusions Over the 10-year study period, early-onset PTLD accounted for only 21% of cases, underscoring the ongoing risk beyond the first post-transplant year. The use of alemtuzumab for induction did not correlate with increased PTLD risk. The disorder commonly affects the transplanted lung and gastrointestinal tract. Despite a predominance of CD20-positive cases, half of the patients could not undergo treatment, resulting in a mortality rate exceeding 90%. These findings highlight the need for vigilant surveillance and timely intervention and underscore the significant impact of PTLD in lung transplant populations.