Posttransplant Lymphoproliferative Disorder Following Pancreas Transplantation

Abstract

The incidence, risk factors and impact on patient and graft survival were evaluated for posttransplant lymphoproliferative disorder (PTLD) among 212 pancreas transplant recipients. Thirteen (6.1%) developed PTLD during 71 ± 27 months follow-up. Cumulative incidences of PTLD at 1, 3, 5 and 10 years posttransplant were 4.2%, 5.3%, 6.0% and 7.0%, respectively. Incidence of PTLD was lower for recipients of simultaneous pancreas kidney compared to pancreas after kidney transplant or pancreas transplant alone, though not significantly so. Recipient Epstein-Barr virus (EBV) seronegativity and number of doses of depleting antibody therapy administered at transplant were associated with increased risk of PTLD, while recipient age, gender, transplant type, cytomegalovirus mismatch maintenance immunosuppression type and treated acute rejection were not. All 13 cases underwent immunosuppression reduction, and 10 received anti-CD20 monoclonal antibody. During follow-up, 10/13 (77%) responded to treatment with complete remission, while 3 (23%) died as a result of PTLD. Patient and graft survivals did not differ for recipients with and without PTLD. The strong association of PTLD with EBV-seronegativity requires considering this risk factor when evaluating and monitoring pancreas transplant recipients. With reduction of immunosuppression and anti-CD20 therapy, survival for pancreas transplant recipients with PTLD was substantially better than previously reported.

Reduction of Immunosuppression as Initial Therapy for Posttransplantation Lymphoproliferative Disorder★

“…Complete and partial withdrawals of immunosuppression resulted in similar rates of response and rejection and in similar survival hazards, but were used in different allograft types and possibly different clinical scenarios, making it difficult to draw any conclusions on a better strategy. More specific information about RI strategies and organ-specific rates of rejection has been published(48, 49). …”

Pancreas transplantation

“…Several reports have described infectious complications 72 73 and relatively high rates of hematologic cancers after pancreas transplantation. 74 Other studies have reported a high rate of complications requiring readmission to hospital. 75 76 However, a lack of uniform definitions regarding complications, local differences in practice patterns, and inconsistent reporting of outcomes by transplant centers limit broader application of such data.…”

Posttransplant Lymphoproliferative Disorder Presenting as a Small Bowel Obstruction in a Patient with Pancreas Transplantation Alone

“…PTLD in PTA has been described in three single-center experiences with all three types of pancreas transplantation (6)(7)(8). In these studies, involving 11 total PTA cases, the reported incidence of PTLD ranged from 1.0% to 8.9%.…”