Objective: To examine the impact of type of immunosuppressive therapy on risk of post-transplant lymphoproliferative disorder (PTLD) in pediatric heart transplant recipients.
Methods: All heart transplant patients followed by two children’s hospitals (1984-2008) were reviewed. Patients surviving longer than 2 months post primary transplant were included (n=324). Mann-Whitney, Chi-square, and Cox hazard modeling were used as appropriate.
Results: Indications for transplant included cardiomyopathy (59%) and congenital heart disease (39%). PTLD developed in 39 patients (12%) at a median time of 2.8 years post transplant (range 0.2-12 years). Median age at transplant for the study population was 10.2 years and was significantly younger in patients who developed PTLD (3.7 vs 10.8 years, p=0.002). Patients with and without PTLD did not differ by sex. Except for 3 patients, all patients were initially treated with cyclosporine post transplant; 31% were changed to tacrolimus at a median of 149 days post transplant (range 5 days-15.7 years). PTLD-free survival was decreased in patients receiving tacrolimus as compared to those receiving cyclosporine only (Figure 1), with a hazard ratio of 3.6 (95% CI 1.9-6.9). The frequency of rejection did not differ between patients with and without PTLD (0.56 vs 0.6 episodes per patient year, p=0.89). Overall survival was worse in patients with PTLD with a hazard ratio of 2.5 (95% CI 1.4-4.3).
Conclusions: Pediatric heart transplant patients treated with tacrolimus have a higher risk of PTLD than those treated with cyclosporine alone.