Association of antiviral prophylaxis and rituximab use with posttransplant lymphoproliferative disorders (PTLDs): A nationwide cohort study |
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| Authors: | Laura N. Walti Catrina Mugglin Daniel Sidler Matteo Mombelli Oriol Manuel Hans H. Hirsch Nina Khanna Nicolas Mueller Christoph Berger Katia Boggian Christian Garzoni Dionysios Neofytos Christian van Delden Cédric Hirzel Swiss Transplant Cohort Study (STCS) |
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| Affiliation: | 1. Department of Infectious Diseases, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland;2. Department of Nephrology and Hypertension, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland;3. Transplantation Center and Service of Infectious Diseases, Lausanne University Hospital (CHUV), Lausanne, Switzerland;4. Division of Infectious Diseases and Hospital Epidemiology, University and University Hospital of Basel, Basel, Switzerland;5. Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich and University Zurich, Zurich, Switzerland;6. Division of Infectious Diseases and Hospital Epidemiology, University Children's Hospital Zurich, Zurich, Switzerland;7. Division of Infectious Diseases and Hospital Hygiene, Cantonal Hospital St. Gallen, St. Gallen, Switzerland;8. Clinic of Internal Medicine and Infectious Diseases, Clinica Luganese, Lugano, Switzerland;9. Transplant Infectious Diseases Unit, Faculty of Medicine, University Hospitals of Geneva, Geneva, Switzerland |
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| Abstract: | Posttransplant lymphoproliferative disorder (PTLD) is a serious complication of solid organ transplantation (SOT). Most PTLD cases are associated with Epstein–Barr virus (EBV) infection. The role of antiviral prophylaxis or rituximab therapy for prevention of PTLD in SOT recipients is controversial. In a nationwide cohort, we assessed the incidence, presentation, and outcome of histologically proven PTLD. We included 4765 patients with a follow-up duration of 23 807 person-years (py). Fifty-seven PTLD cases were identified; 39 (68%) were EBV positive (EBV+ PTLD). Incidence rates for EBV+ PTLD at 1, 2, and 3 years posttransplant were 3.51, 2.24, and 1.75/1000 py and 0.44, 0.25, and 0.29/1000 py for EBV− PTLD. We did not find an effect of antiviral prophylaxis on early and late EBV+ PTLD occurrence (early EBV+ PTLD: SHR 0.535 [95% CI 0.199–1.436], p = .264; late EBV+ PTLD: SHR 2.213, [95% CI 0.751–6.521], p = .150). However, none of the patients (0/191) who received a rituximab-containing induction treatment experienced PTLD, but 57 of 4574 patients without rituximab induction developed PTLD. In an adjusted restricted mean survival time model, PTLD-free survival was significantly longer (0.104 years [95% CI 0.077–0.131]) in patients receiving rituximab as induction treatment. This study provides novel data on the association of rituximab induction and reduced risk for PTLD. |
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| Keywords: | clinical research/practice complication: infectious hematology/oncology immunosuppressant –fusion proteins and monoclonal antibodies: B cell specific infection and infectious agents – viral infection and infectious agents – viral: Epstein-Barr Virus (EBV) infectious disease posttransplant lymphoproliferative disorder (PTLD) |
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