Onset of Post-Transplant Lymphoproliferative Disorder Subtypes in Liver Transplantation: UNOS-STAR Database Analysis

Introduction: Post-transplant lymphoproliferative disorder (PTLD) exhibits diverse clinical presentations, etiologies, and outcomes. While pathological classification exists, a categorization based on clinical presentation has not been established. This study aimed to develop a clinical classification of PTLD after liver transplant (LT) using a large database.

Methods: Using data from the Standard Transplant Analysis and Research database, we identified 2,212 PTLD patients from 1997 to 2023, both adult (>17) and pediatric.

Results: The incidence of PTLD was significantly higher and occurred earlier in children under 5 years old. Over half of pediatric PTLD cases developed within two years. Epstein-Barr virus (EBV)-related PTLD was more frequent (31.8%) before two years than after (19.7%, p<0.01). The prognosis of early-onset EBV-related PTLD was significantly better than that of late-onset non-EBV-related PTLD (p<0.01). In adults, PTLD incidence was higher in male patients over 60 years old and most occurred within 2 years. Adults who developed late-onset PTLD were more likely to have autoimmune liver disease. Prognostic comparisons showed that the prognosis was best for autoimmune liver disease, and worst for male patients over 60 years old (p<0.001).

Conclusion: The onset and patient characteristics of PTLD in children and adults reveal distinct clinical entities with unique behaviors. Early-onset PTLD is predominantly associated with EBV naivety in children and is linked to a favorable post-PTLD prognosis. Early-onset PTLD in adults is more frequently observed in older patients and higher MELD scores, and it is associated with a poorer prognosis. A refined clinical classification of PTLD may facilitate personalized treatment strategies.