Background: Post-transplant lymphoproliferative disorder (PTLD) adversely affects patientsââ?¬â?¢ long-term outcome.\nMethods: The paired t test and McNemarââ?¬â?¢s test were applied in a retrospective 1:1 matched-pair analysis including\n36 patients with PTLD and 36 patients without PTLD after kidney or liver transplantation. Matching criteria were age,\ngender, indication, type of transplantation, and duration of follow-up. All investigated PTLD specimen were histologically\npositive for EBV. Risk-adjusted multivariable regression analysis was used to identify independence of risk factors for PTLD\ndetected in matched-pair analysis. The resultant prognostic model was assessed with ROC-curve analysis.\nResults: Patients suffering with PTLD had shorter mean survival (p = 0.004), more episodes of CMV infections or\nreactivations (p = 0.042), and fewer recipient HLA A2 haplotypes (p = 0.007), a tacrolimus-based immunosuppressive\nregimen (p = 0.052) and higher dosages of tacrolimus at hospital discharge (Tac dosage) (p = 0.052). Significant\nindependent risk factors for PTLD were recipient HLA A2 (OR = 0.07, 95 % CI = 0.01ââ?¬â??0.55, p = 0.011), higher Tac\ndosages (OR = 1.29, 95 % CI = 1.01ââ?¬â??1.64, p = 0.040), and higher numbers of graft rejection episodes (OR = 0.38,\n95 % CI = 0.17ââ?¬â??0.87, p = 0.023). The following prognostic model for the prediction of PTLD demonstrated good\nmodel fit and a large area under the ROC curve (0.823): PTLD probability in % = Exp(y)/(1 + Exp(y)) with y = 0.671\nâË?â?? 1.096 Ã?â?? HLA A2-positive recipient + 0.151 Ã?â?? Tac dosage âË?â?? 0.805 Ã?â?? number of graft rejection episodes.\nConclusions: This study suggests prognostic relevance for recipient HLA A2, CMV, and EBV infections or reactivations\nand strong initial tacrolimus-based immunosuppression. Patients with risk factors may benefit from intensified\nscreening for PTLD.
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