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Kidney Int. 2018 Oct;94(4):809-817. doi: 10.1016/j.kint.2018.06.009. Epub 2018 Aug 30.

Post-transplant lymphoproliferative disease may be an adverse risk factor for patient survival but not graft loss in kidney transplant recipients.

Author information

1
Sydney School of Public Health, University of Sydney, Camperdown, New South Wales, Australia; Centre for Kidney Research at The Children's Hospital at Westmead, Sydney, New South Wales, Australia; Child and Adolescent Renal Service, Children's Health Queensland, Brisbane, Queensland, Australia. Electronic address: anna.francis@health.qld.gov.au.
2
Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia; Australasian Kidney Trials Network, Diamantina Institute, University of Queensland, Brisbane, Queensland, Australia; Translational Research Institute, Brisbane, Queensland, Australia.
3
Sydney School of Public Health, University of Sydney, Camperdown, New South Wales, Australia; Centre for Kidney Research at The Children's Hospital at Westmead, Sydney, New South Wales, Australia.
4
Sydney School of Public Health, University of Sydney, Camperdown, New South Wales, Australia; Centre for Kidney Research at The Children's Hospital at Westmead, Sydney, New South Wales, Australia; Centre for Transplant and Renal Research, Westmead Hospital, Sydney, New South Wales, Australia; Australian and New Zealand Dialysis and Transplant Registry, Adelaide, South Australia, Australia.

Abstract

Better prognostication of graft and patient outcomes among kidney transplant recipients with post-transplant lymphoproliferative disease (PTLD) in the rituximab era is needed to inform treatment decisions. Therefore, we sought to estimate the excess risks of death and graft loss in kidney transplant recipients with PTLD, and to determine risk factors for death. Using the ANZDATA registry, the risks of mortality and graft loss among recipients with and without PTLD were estimated using survival analysis. A group of 367 patients with PTLD (69% male, 85% white, mean age 43 years) were matched 1 to 4 to 1468 controls (69% male, 88% white, mean age 43 years), and followed for a mean of 16 years. Recipients with PTLD experienced poorer 10-year patient survival (41%, 95% confidence intervals 36-47%) than controls (65%, 63-68%). Excess mortality occurred in the first 2 years post-transplant (hazard ratio 8.5, 6.7-11), but not thereafter (1.0, 0.76-1.3). Cerebral lymphoma (2.0, 1.3-3.1), bone marrow disease (2.0, 1.2-3.3) and year of diagnosis prior to 2000 (2.2, 1.4-3.5; after 2000 reference) were risk factors of death. PTLD did not confer an excess risk of graft loss (1.08, 0.69-1.70). Thus, PTLD is a risk factor for death, particularly in the first two years after diagnosis. Cerebral or bone marrow diseases were associated with increased mortality risk, but overall survival in the rituximab era (post 2000) has improved.

KEYWORDS:

adult; child; graft survival; kidney transplantation; lymphoproliferative disease; mortality

PMID:
30173897
DOI:
10.1016/j.kint.2018.06.009
[Indexed for MEDLINE]

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