Gore, Edmund (2020) Reduction of immunosuppression based on whole blood EBV viral loads in lung transplant recipients A single centre patient cohort study. thesis, Medicine.
Full text available on request.Abstract
Post-transplant lymphoproliferative disease (PTLD) affects up to 10% of lung transplant recipients and a has potential five year overall survival of 39% (1). Prevention of the disease is therefore key which is primarily done through reduction of immunosuppression (RIS) based on EBV viral loads. The safety of this approach has been questioned as the risk of acute and chronic rejection increases following the withdrawal of immunosuppression. 26 patients who underwent RIS were matched with 26 patients who did not (NRIS) using; age, date of transplantation, gender, presence of primary EBV infection, EBV viral load and cystic fibrosis status. Risk of PTLD, acute rejection, overall survival and chronic lung allograft dysfunction (CLAD) was analysed using Kaplan-Meier survival analysis and Cox regression models. RIS did not protect patients from developing PTLD with three cases occurring in both groups. Time to PTLD from RIS was also not different with a median time to PTLD of 13.8 [IQR 12.2-15.3] years for RIS and 13.4 [IQR 11.9-14.8] years for the NRIS group. RIS did not increase the risk of acute rejection HR 1.56 [95% CI 0.46-5.32], p >0.05 but did increase the risk of developing CLAD in the long term HR 3.25 [95% CI 1.19-8.85], p =0.02.This small scale study suggests RIS could have long term consequences for lung transplantation patients. However, the length of time between RIS and the diagnosis of CLAD makes a causal link between the two events less likely.
| Item Type: | Thesis (UNSPECIFIED) |
|---|---|
| Supervisor name: | Professor Niesters, Hubert and Dr. van Leer-Buter, Coretta |
| Faculty: | Medical Sciences |
| Date Deposited: | 26 Sep 2023 11:08 |
| Last Modified: | 26 Sep 2023 11:08 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/3695 |
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