PTLD After Heart Transplantation

PTLD in adult and childhood heart transplant recipients remains poorly understood but is associated with double the mortality compared to recipients without PTLD. PTLD makes up the minority of malignancies (1%) in adults post-heart transplant, and, other than younger age, there is a clear paucity of data in the literature regarding risk factors for development and/or outcomes. In children, PTLD is a bigger problem (5–15% incidence) with an ongoing gradual increase in the likelihood of getting PTLD over time post-transplant. EBV status and the age of the child at the time of transplant are both important risk factors with complex interactions. Heart allograft involvement with PTLD is very rare. Rejection has been reported to be as frequent as a cause of death as PTLD itself in children, likely in relation to the reduction of immunosuppression management approach to PTLD. There remain significant gaps in the literature regarding PTLD post-heart transplantation.