Analysis of Factors that Influence Survival with Post-Transplant Lymphoproliferative Disorder in Renal Transplant Recipients: The Israel Penn International Transplant Tumor Registry Experience

Abstract

Significant mortality is associated with posttransplant lymphoproliferative disorder (PTLD) in kidney transplant recipients (KTX). Univariate/multivariate risk factor survival analysis of US PTLD KTX reported to Israel Penn International Transplant Tumor Registry from November 1968 to January 2000 was performed. PTLD presented 18 (median) (range 1-310) months in 402 KTX. Death rates were greater for those diagnosed within 6 months (64%) versus beyond 6 months (54%, p = 0.04). No differences in death risk for gender, race, immunosuppression, EBV, B or T cell positivity were identified. Death risk increased for multiple versus single sites (73% vs. 53%, hazards ratio (HR) 1.4). A 1-year increase in age increased HR for death by 2%. Surgery was associated with increased survival (55% vs. 0% without surgery) (p < 0.0001). Patients with allograft involvement, treated with transplant nephrectomy alone (n = 20), had 80% survival versus 53% without allograft removal (n = 15) (p < 0.001). Overall survival was 69% for allograft involvement alone versus 36% for other organ involvement plus allograft (n = 19 alive) (p < 0.0001). Death risk was greater for multiple site PTLD and increasing age, and risks were additive. Univariate analysis identified increased death risk for those not receiving surgery, particularly allograft involvement alone.

No Increased Risk of Posttransplant Lymphoproliferative Disorder Following Alemtuzumab Induction in Kidney Transplant

“…Trofe and associates demonstrated that patients with a B-cell-predominant PTLD had a 33% survival rate versus 49% in those without this form. 5 Our patient demographic results followed trends seen in PTLD patients. Nine of the 10 PTLD-positive patients were White males.…”

“…1,11 Age-associated mortality is not related to a specific age; however, the time between transplant and diagnosis of PTLD is associated with mortality. 5 Patients who were diagnosed within 1 year after transplant had a greater risk of dying. 5 In our study, half of the patients who succumbed to their illness were diagnosed with PTLD within 1 year of transplant.…”

“…1 Trofe and associates showed that neither ethnicity nor sex had any associated risk with mortality. 5 The average age of our PTLD patients at transplant was 61.9 years old, with the youngest being 50 years and oldest being 75 years. The average age of patients in our non-PTLD group was 52 years.…”

“…9 B-cell predominance has been shown to be associated with lower survival rates. 5 In our study, half of the known patients with B-cell PTLD were deceased when our data were collected. Trofe and associates demonstrated that patients with a B-cell-predominant PTLD had a 33% survival rate versus 49% in those without this form.…”

“…4 Mortality has been shown to be roughly 50%, with some variations associated with time of diagnosis since transplant, multiple-versus single-site cancer location, B-cell-predominant malignancy, and the continued increased risk after the first year of diagnosis. 3,4,5 A number of factors have been associated with the development of PTLD, including transplant from EBV-seropositive donors to EBV-seronegative recipients, coexisting cytomegalovirus (CMV) infection, and the use of certain immunosuppressive agents such as muromonab-CD3 (OKT3) or tacrolimus. 6,7 Depleting induction agents have also been shown to have varying associations with PTLD incidence.…”