Incidence and outcomes of post-transplant lymphoproliferative disorder in the Western Australian liver transplant population: a 24-year retrospective study

Background: Post-transplant lymphoproliferative disorder (PTLD) is the most common malignancy following solid organ transplants, affecting 1% to 4% of liver transplant recipients. Recent advancements have shifted the management of B-cell PTLD, with rituximab (a monoclonal anti-CD20 antibody) now used as the first-line treatment, while chemotherapy is reserved for patients with inadequate responses. Reducing immunosuppression remains a key aspect of management but can lead to organ rejection and even necessitate re-transplantation.

Aims: This study aimed to assess the prevalence, characteristics and outcomes of PTLD in Western Australian liver transplant recipients over 24 years.

Methods: We used hepatology and haematology databases to identify liver transplant recipients who developed PTLD from 1999 to 2023.

Results: Among 476 liver transplants, 16 patients developed PTLD, an incidence of 3.4%. PTLD occurred at a median of 66.5 months post-transplant. Most cases were B-cell lymphomas, CD20-positive and associated with Epstein-Barr virus (EBV) infection. First-line treatments included rituximab with chemotherapy (n = 7) and rituximab monotherapy (n = 5). The overall response rate was 69%, with 11 patients achieving complete remission at 6 months. One-, three- and five-year survival rates were 75%, 50% and 50%, respectively. Factors such as EBV load, lactate dehydrogenase levels and age did not significantly impact remission. Seven patients (44%) experienced graft rejection. Three patients underwent repeat transplant during the study period and remained alive at the conclusion of the study period.

Conclusion: Rituximab-based treatments demonstrated promising outcomes, though graft rejection remains a challenge. Further research is needed to optimise treatment and reduce rejection risks in PTLD patients.