Improved Survival with Recent Post-Transplant Lymphoproliferative Disorder (PTLD) in Children with Kidney Transplants

Abstract

Post-transplant lymphoproliferative disorder (PTLD) has been associated with high mortality, but recent anecdotal survival appeared better. From 1988 to 2010, the NAPRTCS registry had 235 registered PTLD cases. We sent a special 25-point questionnaire study to the NAPRTCS centers with the most recent 150 cases to obtain additional follow-up data not collected in the master registry, our objective being to determine the recent outcomes after PTLD and determine prognostic factors. We received 92 completed responses, in which only 12 (13%) deaths were reported, 2 from nonmedical causes, 10 with a functioning graft. Kaplan-Meiercalculated patient survival was 90.6% at 1 year and 87.4% at 3, 4 and 5 years post-PTLD. Graft survival post-PTLD was 81.8% at 1 year, 68.0% at 3 years and 65.0% at 5 years. Seven patients received a retransplant after PTLD, with no PTLD recurrence reported. Using all 235 PTLD cases, the covariates associated with better patient survival were more recent year of PTLD diagnosis (adjusted hazard ratio AHR 0.86, p < 0.001), and with worse survival were late PTLD (AHR 1.98, p = 0.0176) and patient age above 13 at PTLD (AHR 3.43, p value 0.022). In children with kidney transplants, patient survival has improved with more recent PTLDs.

Comprehensive review of post–organ transplant hematologic cancers

“…115 Similar data have been shown in the national French PTLD registry, where graft survival was significantly inferior in patients with posttransplantation NHL compared to those transplant patients without NHL. From data in children after kidney transplant, graft survival post-PTLD was 81.8% at 1 year, 68.0% at 3 years, and 65.0% at 5 years.…”

Identifying the Prognosis Factors in Death after Liver Transplantation via Adaptive LASSO in Iran

“…In a study about complications and mortality after liver transplantation, both univariate and multivariate analyses revealed a significant association between vascular complication and mortality of recipients [23]. As another result of the current study, like the other studies, we found that PTLD can increase the risk of death [24, 25]. And finally in contrast to our study, factors like the recipient's age, comorbidity disease, previous abdominal surgery, and MELD were reported as death risk factors after transplantation [2, 14, 26].…”

Posttransplant Lymphoproliferative Disease after Pediatric Solid Organ Transplantation

“…No significant prognostic factors were identified in the prospective trials by Gross and colleagues. In retrospective analyses bone marrow or CNS involvement, EBV-negative tumors, lack of CD20 expression and very early or late PTLD development were adverse prognostic factors in terms of survival ([15, 23, 101, 102] and BMK, unpublished results). However, historical data need to be confirmed in prospective clinical trials, especially regarding the impact of rituximab introduction in the early new millennium.…”