Posttransplantation
lymphoproliferative disorder (PTLD) is an important complication of
transplantation. Risk factors include increased overall immunosuppression exposure and inadequate
antiviral prophylaxis; however, the effects of T-cell-depleting agents on PTLD are unclear. A systematic literature review was conducted to assess PTLD in clinical studies published 1999-2009 in transplant patients with ≥ 3 years follow-up who received
Thymoglobulin for induction. Twenty studies were identified (12 kidney, 7 heart, and 1 liver), of which 3 were excluded for insufficient PTLD reporting. The final study group comprised 2,246 kidney and heart transplant recipients (liver study excluded) who received
Thymoglobulin. At a median follow-up of 5 years, the incidence of PTLD was 0.98% (kidney, 0.93%; heart, 1.05%) among
Thymoglobulin-treated patients. The cumulative
Thymoglobulin dose reported in these studies was not associated with the development of PTLD (P = NS). However, incidence of PTLD was significantly lower with
antiviral prophylaxis (0.63%) than without (1.87%; P = .013). Heart transplant recipients not receiving
antiviral prophylaxis had the highest PTLD incidence, possibly attributable to a greater overall immunosuppressive burden. This analysis revealed that PTLD incidences in kidney and heart transplant recipients receiving
Thymoglobulin were low overall and perhaps related more to concomitant anti-viral prophylaxis use.