Lung retransplantation after posttransplantation lymphoproliferative disorder (PTLD): a single-center experience and review of literature of PTLD in lung transplant recipients.

BACKGROUND: Retransplantation in adult lung transplant recipients developing progressive bronchiolitis obliterans syndrome as a consequence of posttransplantation lymphoproliferative disorder (PTLD) therapy has not been reported in the literature. Literature on PTLD after lung transplantation is limited mostly to case reports or small case series, limiting the validity of conclusions. METHODS: Retrospective chart review of patients at our center. Analysis of pooled data published on lung transplant patients developing PTLD. RESULTS: Two patients who underwent pulmonary retransplants for PTLD have functioning grafts 23 and 36 months postoperatively, with no evidence of PTLD recurrence. Review and analysis of published data and from our center revealed that incidence of PTLD, proportion of patients with thoracic involvement, and proportion of patients who were Epstein-Barr virus seronegative before transplantation decreased continuously as a function of time from transplant. Patients developing PTLD within the first 6 months after transplantation had a clinically distinct pattern of PTLD and a significantly better survival than patients developing PTLD more than 6 months after lung transplant. CONCLUSIONS: Lung retransplantation can be considered after careful selection for lung transplant recipients developing bronchiolitis obliterans syndrome as a consequence of reduced immunosuppression for PTLD. Acquisition of PTLD and pattern of organ involvement is a continuous process as a function of time. Defining "early PTLD" as occurring in the first 6 months more accurately predicts progress and prognosis of this disease than the traditional 1 year definition of early vs late onset PTLD.