Association of Antiviral Prophylaxis and Rituximab Use with Post-transplant Lymphoproliferative Disorders (PTLD): A Nationwide Cohort Study
Journal Paper/Review - Dec 2, 2020
Walti Laura N, Mugglin Catarina, Sidler Daniel, Mombelli Matteo, Manuel Oriol, Hirsch Hans H, Khanna Nina, Mueller Nicolas, Christoph Berger, Boggian Katia, Garzoni Christian, Neofytos Dionysios, Van Delden Christian, Hirzel Cédric, Transplant Cohort Study Stcs Swiss
Post-transplant 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 4'765 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 post-transplant were 3.51; 2.24; 1.75/1'000 py and 0.44; 0.25; 0.29/1'000 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=0.264; late EBV+ PTLD: SHR 2.213, [95% CI 0.751-6.521], p=0.150). However, none of the patients (0/191) who received a rituximab-containing induction treatment experienced PTLD, but (57/4'574) 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.