Post-Transplant Lymphoproliferative Disorders Occurring After Renal Transplantation in Adults: Report of 230 Cases From the French Registry

Abstract

Post-transplant lymphoproliferative disorders (PTLD) are a rare but serious complication after organ transplantation. A French Registry of PTLD was set up in a nationwide population of kidney transplant recipients. We prospectively enrolled all adult kidney recipients developing PTLD between January 1, 1998, and December 31, 2003. We analyzed the incidence, risk and prognostic factors of PTLD by Kaplan-Meier and Cox analyses. Totally 230 cases of PTLD were referred to the French Registry. Cumulative incidence was 1.18% after 5 years. Older age (per year, AHR = 2.19, CI = 1.22-3.94) and recipient Epstein-Barr virus seronegativity (AHR = 3.01, CI = 1.57-5.08) were associated with an increased risk of PTLD. Patients with PTLD had a reduced survival rate (61% at 5 years). Graft PTLD had the best prognosis with an 81% survival rate after 5 years. Infection with hepatitis C or B virus (HCV or HBV), late-onset PTLD, multiple sites involvement and high Ann Arbor staging were risk factors for patient death. Use of azathioprine was associated with a poorer survival rate. PTLD incidence and risk factors in French recipients are in line with the international or American PTLD series. We highlighted the role of HBV or HCV in patient mortality and described the relevant prognosis factors for patients with post-transplant lymphoproliferations.

Enfermedad linfoproliferativa postrasplante de órgano sólido

“…Trasplante multivisceral > intestino > pulmón > corazón/pulmón > corazón > riñón Presencia de malignidades pretrasplante La incidencia de ELPT tiene una distribución bimodal, con un pico temprano (primeros dos años postrasplante), y uno tardío, con diferencias en los factores de riesgo y los hallazgos histológicos, lo que sugiere mecanismos diferentes para su producción. Los casos tempranos parecen ser mediados principalmente por la infección con VEB en el contexto de la inmunosupresión profunda, y los tardíos se relacionan con la inmunosupresión prolongada, la edad avanzada y probablemente la exposición a agentes específicos, lo cual se ha evidenciado en diferentes estudios (5)(6)(7)(8).…”

“…En los pacientes con trasplante renal, el TGI es el sitio extranodal afectado con mayor frecuencia (15 % a 22 %), mientras que la ELPT se localiza en el injerto en 10 % a 20 % de los casos (8,22), y es la enfermedad del injerto más frecuente en los pacientes con trasplante de pulmón (22). El compromiso del sistema nervioso central es más raro, desde menos del 10 % hasta el 20 %, con mayor frecuencia en los casos de trasplante de páncreas y riñón, y en aproximadamente la mitad de los casos ocurre como enfermedad aislada (8,22,27).…”

Infectious Complications in Kidney Transplantation

“…Observational studies have suggested KTRs with EBV disease are at high risk of developing PTLD (Dharnidharka et al, 2001b). Observational studies have also shown that mortality from EBV-associated PTLD is over 50% (Caillard et al, 2006;Opelz & Dohler, 2004). The presence of immunosuppression is major risk factor for the development of EBV disease, including PTLD, in KTRs (Dharnidharka & Harmon, 2001a;McDonald et al, 2008).…”

Epstein-Barr virus-associated lymphoproliferative disorder developed following autologous peripheral blood stem cell transplantation for relapsing Hodgkin’s lymphoma

“…The development of PTLD is usually associated with Epstein-Barr virus (EBV) and the disorder is also termed EBV-associated LPD. The risk of developing PTLD varies; patients receiving renal allografts have the lowest frequency of PTLD (<1%), those with hepatic and cardiac allografts have an intermediate risk (1-2%) and those with heart-lung, lung or intestinal allografts have the highest frequency (>5%) (2)(3)(4). Peripheral blood, stem cell and bone marrow allograft recipients have a low risk of PTLD (~1%) and PTLD is rare following autologous bone marrow transplantation (5)(6)(7)(8)(9)(10)(11).…”