Work

Circulating Epstein–Barr virus DNA and high‐risk extra‐nodal involvement identify disease‐specific mortality in post‐transplant lymphoproliferative disorder

Year: 2026

Type: article

Abstract: Post-transplant lymphoproliferative disorder (PTLD) is a heterogeneous disorder arising in the context of immunosuppression after solid organ transplantation. Determinants of PTLD-specific mortality remain poorly defined, as conventional survival analyses may not adequately capture disease-attributable risk given substantial competing mortality. We performed a retrospective analysis of 75 solid organ transplant recipients with PTLD, using a competing-risk framework with Fine-Gray subdistribution hazard regression to identify factors associated with PTLD-related death, accounting for non-PTLD mortality. Over a median follow-up of 71.0 months, 35 patients (46.7%) died, of whom 25 (71.4%) experienced PTLD-related death. After adjustment for International Prognostic Index (IPI), high-risk extra-nodal involvement (bone marrow or central nervous system) remained associated with PTLD-related mortality (subdistribution hazard ratio [sHR], 3.82; 95% confidence interval [CI], 1.67-8.73; p = 0.001), as did detectable circulating Epstein-Barr virus (EBV) deoxyribonucleic acid (DNA) (sHR, 4.38; 95% CI, 1.63-11.76; p = 0.003). Combined tissue and blood EBV stratification further revealed a hierarchical mortality gradient across four EBV-defined subgroups (dual-positive to dual-negative). High-risk extra-nodal involvement and detectable circulating EBV DNA are independently associated with PTLD-attributable mortality after adjustment for IPI. Combined tissue and circulating EBV assessment may provide complementary prognostic information. Prospective validation in larger multicentre cohorts is warranted.

Source: British Journal of Haematology

DOI: 10.1111/bjh.70941