A French Cohort Study of Kidney Retransplantation after Post-Transplant Lymphoproliferative Disorders.
Clin J Am Soc Nephrol
; 12(10): 1663-1670, 2017 Oct 06.
Article
in En
| MEDLINE
| ID: mdl-28818847
ABSTRACT
BACKGROUND AND OBJECTIVES:
Post-transplant lymphoproliferative disorders arising after kidney transplantation portend an increased risk of morbidity and mortality. Retransplantation of patients who had developed post-transplant lymphoproliferative disorder remains questionable owing to the potential risks of recurrence when immunosuppression is reintroduced. Here, we investigated the feasibility of kidney retransplantation after the development of post-transplant lymphoproliferative disorder. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We reviewed the data from all patients who underwent kidney retransplantation after post-transplant lymphoproliferative disorder in all adult kidney transplantation centers in France between 1998 and 2015.RESULTS:
We identified a total of 52 patients with kidney transplants who underwent 55 retransplantations after post-transplant lymphoproliferative disorder. The delay from post-transplant lymphoproliferative disorder to retransplantation was 100±44 months (28-224); 98% of patients were Epstein-Barr virus seropositive at the time of retransplantation. Induction therapy for retransplantation was used in 48 patients (i.e., 17 [31%] patients received thymoglobulin, and 31 [57%] patients received IL-2 receptor antagonists). Six patients were also treated with rituximab, and 53% of the patients received an antiviral drug. The association of calcineurin inhibitors, mycophenolate mofetil, and steroids was the most common maintenance immunosuppression regimen. Nine patients were switched from a calcineurin inhibitor to a mammalian target of rapamycin inhibitor. One patient developed post-transplant lymphoproliferative disorder recurrence at 24 months after retransplantation, whereas post-transplant lymphoproliferative disorder did not recur in 51 patients.CONCLUSIONS:
The recurrence of post-transplant lymphoproliferative disorder among patients who underwent retransplantation in France is a rare event.Key words
Adult; Antilymphocyte Serum; Antiviral Agents; Calcineurin; Calcineurin Inhibitors; Cohort Studies; Epstein-Barr Virus Infections; France; Herpesvirus 4, Human; Humans; Lymphoproliferative Disorders; Mycophenolic Acid; Neoplasm Recurrence, Local; Receptors, Interleukin-2; Reoperation; Rituximab; immunosuppression; kidney; kidney transplantation; thymoglobulin
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Kidney Transplantation
/
Immunosuppressive Agents
/
Lymphoproliferative Disorders
Type of study:
Diagnostic_studies
/
Etiology_studies
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limits:
Adult
/
Aged
/
Female
/
Humans
/
Male
/
Middle aged
Country/Region as subject:
Europa
Language:
En
Journal:
Clin J Am Soc Nephrol
Journal subject:
NEFROLOGIA
Year:
2017
Document type:
Article