Association of Antiviral Prophylaxis and Rituximab Use with Post-transplant Lymphoproliferative Disorders (PTLD): A Nationwide Cohort Study.

Walti, Laura N.; Mugglin, Catrina; Sidler, Daniel; Mombelli, Matteo; Manuel, Oriol; Hirsch, Hans H.; Khanna, Nina; Mueller, Nicolas; Berger, Christoph; Boggian, Katia; Garzoni, Christian; Neofytos, Dionysios; van Delden, Christian; Hirzel, Cédric; Transplant Cohort Study Stcs, Swiss (2020). Association of Antiviral Prophylaxis and Rituximab Use with Post-transplant Lymphoproliferative Disorders (PTLD): A Nationwide Cohort Study. (In Press). American journal of transplantation Wiley-Blackwell 10.1111/ajt.16423

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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.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Dermatology, Urology, Rheumatology, Nephrology, Osteoporosis (DURN) > Clinic of Nephrology and Hypertension
04 Faculty of Medicine > Department of Haematology, Oncology, Infectious Diseases, Laboratory Medicine and Hospital Pharmacy (DOLS) > Clinic of Infectiology

UniBE Contributor:

Walti, Laura Naëmi; Mugglin, Catrina; Sidler, Daniel and Hirzel, Cédric

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1600-6135

Publisher:

Wiley-Blackwell

Language:

English

Submitter:

Annelies Luginbühl

Date Deposited:

05 Jan 2021 12:10

Last Modified:

05 Jan 2021 12:19

Publisher DOI:

10.1111/ajt.16423

PubMed ID:

33289340

BORIS DOI:

10.48350/149622

URI:

https://boris.unibe.ch/id/eprint/149622

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