Post-transplant lymphoproliferative disorders following liver transplantation: Incidence, risk factors and survival

W. K. Kremers, H. C. Devarbhavi, R. H. Wiesner, R. A.F. Krom, W. R. Macon, T. M. Habermann

Research output: Contribution to journalArticlepeer-review

111 Scopus citations


This study investigates retrospectively the incidence, risk factors and mortality of post-transplant lymphoproliferative disorders (PTLD) in adult orthotopic liver transplant (OLT) recipients. Among 1206 OLT recipients at a single institution, 37 developed a PTLD. The incidence of PTLD was highest during the first 18 months and relatively constant thereafter with cumulative incidence of 1.1% at 18 months and 4.7% at 15 years. The risk of PTLD was approximately 10% to 15% of the risk of death without PTLD. During the first 4 years following OLT, PTLD were predominantly related to EBV, while afterward most PTLD were EBV negative. Significant risk factors for PTLD in OLT recipients were transplantation for acute fulminant hepatitis during the first 18 months following OLT (HR = 2.6, p = 0.007), and rejection therapy with high-dose steroids (HR = 4.5, p = 0.049) and OKT3 (HR = 3.9, p = 0.016) during the previous year. Therapy with high-dose steroids or OKT3 (HR = 3.6, p = 0.0071) were also significant risk factors for PTLD-associated mortality. OLT recipients remain at risk for PTLD years after transplantation. The strong association of PTLD with rejection therapy and the worse post-PTLD prognosis among recipients of rejection therapy indicate the need to balance the risk of immunosuppression against the risk of PTLD following rejection treatment.

Original languageEnglish (US)
Pages (from-to)1017-1024
Number of pages8
JournalAmerican Journal of Transplantation
Issue number5 I
StatePublished - May 2006


  • Epstein-Barr virus
  • Liver transplantation
  • Lymphoproliferative disorder
  • Post-transplant complications
  • Rejection
  • Steroids

ASJC Scopus subject areas

  • Immunology and Allergy
  • Transplantation
  • Pharmacology (medical)


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