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Idiopathic pulmonary fibrosis lung transplant recipients are at increased risk for EBV‐associated posttransplant lymphoproliferative disorder and worse survival
Author(s) -
Iasella Carlo J.,
Winters Spencer A.,
Kois Abigail,
Cho Jaehee,
Hannan Stefanie J.,
Koshy Ritchie,
Moore Cody A.,
Ensor Christopher R.,
Lendermon Elizabeth A.,
Morrell Matthew R.,
Pilewski Joseph M.,
Sanchez Pablo G.,
Kass Daniel J.,
Alder Jonathan K.,
Nouraie S. Mehdi,
McDyer John F.
Publication year - 2020
Publication title -
american journal of transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.89
H-Index - 188
eISSN - 1600-6143
pISSN - 1600-6135
DOI - 10.1111/ajt.15756
Subject(s) - medicine , alemtuzumab , hazard ratio , idiopathic pulmonary fibrosis , post transplant lymphoproliferative disorder , proportional hazards model , lung transplantation , lymphoproliferative disorders , gastroenterology , population , incidence (geometry) , confidence interval , transplantation , oncology , lung , lymphoma , rituximab , environmental health , physics , optics
Epstein‐Barr virus (EBV)–associated posttransplant lymphoproliferative disorder (EBV‐PTLD) is a serious complication in lung transplant recipients (LTRs) associated with significant mortality. We performed a single‐center retrospective study to evaluate the risks for PTLD in LTRs over a 7‐year period. Of 611 evaluable LTRs, we identified 28 cases of PTLD, with an incidence of 4.6%. Kaplan‐Meier analysis showed a decreased freedom from PTLD in idiopathic pulmonary fibrosis (IPF)‐LTRs ( P < .02). Using a multivariable Cox proportional hazards model, we found IPF (hazard ratio [HR] 3.51, 95% confidence interval [CI] 1.33‐8.21, P = .01) and alemtuzumab induction therapy (HR 2.73, 95% CI 1.10‐6.74, P = .03) as risk factors for PTLD, compared to EBV mismatch (HR: 34.43, 95% CI 15.57‐76.09, P < .0001). Early PTLD (first year) was associated with alemtuzumab use ( P = .04), whereas IPF was a predictor for late PTLD (after first year) ( P = .002), after controlling for age and sex. Kaplan‐Meier analysis revealed a shorter time to death from PTLD in IPF LTRs compared to other patients ( P = .04). The use of alemtuzumab in EBV mismatch was found to particularly increase PTLD risk. Together, our findings identify IPF LTRs as a susceptible population for PTLD. Further studies are required to understand the mechanisms driving PTLD in IPF LTRs and develop strategies to mitigate risk.