Post-transplant lymphoproliferative disorder following multivisceral transplantation: Incidence, risk factors, and outcomes in an adult UK cohort

Background: Post transplant lymphoproliferative disorder (PTLD) incidence is highest in patients undergoing intestinal and multivisceral transplantation (MVT). We describe our experience of PTLD in a large cohort of adult MVT patients. Materials and methods: We performed a retrospective cohort study of 163 consecutive patients undergoing intestinal and multivisceral transplantation with alemtuzumab based induction from 2007 to 2024. Clinical data were obtained from patient records. Univariate analyses were performed to assess factors associated with PTLD development. Results: Twenty-nine patients (17.8 %) developed PTLD, of which 28/29 (96.6 %) were EBV associated. Cumulative incidence of PTLD adjusting for competing risk of death was 14.1 %, 19.7 % and 24.9 % at 1, 5, and 10 years, respectively. In those who developed PTLD median time to development of EBV viraemia was 6.6 months. Median initial EBV viral load log was 3.6. EBV serology mismatch between donor/recipient was the only variable significantly associated with PTLD development (OR 7.7, CI 2.9-20.0, P < 0.001). All patients received rituximab monotherapy initially. Of patients who had end of treatment radiological assessment (n = 23), overall response rate to rituximab was 56.5 %. Conclusion: There is a high incidence of PTLD in patients within the first year post intestinal transplant. EBV matching status is a potentially modifiable risk factor for PTLD development.