Hepatic Lymphomas Post Renal Transplantation May Signify Worse Disease Behavior: Analysis of Data from 26 International Studies

Introduction: Hepatic involvement by posttransplant lymphoproliferative disorders (PTLD) is an important but rarely investigated issue. In the current study, we aimed to pool data of cases of PTLD localization in liver (L-PTLD) among renal allograft recipients from different series to find new perspectives on the disease. Methods: We conducted a comprehensive search for the available data through PubMed and Google Scholar for reports of PTLD localization in the liver and surrounding lymph nodes in renal allograft recipients. Data of 232 cases from 26 international studies have been pooled and reanalyzed. Results: Patients with L-PTLD were significantly more likely to be of male gender (P=0.02). Death due to PTLD was higher in L-PTLD patients (P=0.06). Disseminated PTLD, based on our definition, was significantly more prevalent in L-PTLD than in none-liver-PTLD (NL-PTLD) (P<0.001); the same finding was noted with multi-organ involvement which was significantly higher in L-PTLD (P<0.001). L-PTLD was significantly more likely to complicate heart (P=0.03), bone marrow (P=0.002), spleen (P=0.01), and kidney allograft involvement (P=0.04). Conclusion We conclude that renal transplant patients exhibiting liver localization for PTLD should be carefully followed for multi-organ involvement. Most notably, bone marrow biopsy should be considered, and evaluations for renal allograft, heart and spleen localization for PTLD should be executed. Due to the unfavorable characters of liver localization by PTLD in renal recipients, we propose higher levels of evaluations and follow up for these patients. Prospective studies with larger patient populations are needed to confirm our results.