Early and Late-onset PTLD

PTLD=Post-transplant Lymphoproliferative Disorder

Risk Factors for Early-onset and Late-onset Post-transplant Lymphoproliferative Disorder in U.S. Kidney Recipients
S.C. Quinlan,1 R.M. Pfeiffer,1 L.M. Morton,1 and E.A. Engels

February 2011


Incidence of post-transplant lymphoproliferative disorder (PTLD) is bimodal, suggesting distinct early-onset and late-onset subtypes.

We evaluated differences in risk factors for early-onset and late-onset PTLD in a retrospective cohort study of U.S. kidney transplant recipients using data from the Scientific Registry of Transplant Recipients (N=156,740, 1999–2007)….

For early-onset PTLD, significantly increased risk was associated with young age at transplantation (HR 3.97 for <20 vs. 20–50 years), non-Hispanic white race/ethnicity (HR 1.82), and seronegativity for Epstein Barr virus (EBV) and cytomegalovirus at transplantation (HRs 3.13 and 1.49, respectively).

By comparison, younger and older age (HRs 2.68 and 1.28 for <20 and >50, respectively, vs. 20–50 years) and non-Hispanic white race/ethnicity (HR 1.77) increased late-onset PTLD risk.

These results support somewhat different etiologies for early-onset and late-onset PTLD. For early-onset PTLD, associations with young age and EBV seronegativity highlight the etiologic role of primary EBV infection. For late-onset PTLD, higher risk with older age is consistent with lymphoma patterns in the general population.