Background: Majority of Post transplant lymphoproliferative disorders(PTLD) occur in the first year post solid organ transplant. The risk factors for development of PTLD include degree of T cell suppression, pre-transplant malignancy, EBV serostatus and fewer HLA mismatches. In our single centre retrospective study of renal transplant recipients over 30 years, we analysed the onset of PTLD, type and site of PTLD, survival post chemotherapy and rate of recurrence with an aim of comparing our results with national and international transplant units.

Methods: We collected data from EPR, Medisec and patient records, analysed it using excel spreadsheet and applied statistical methods to obtain results.

Results: Although our data showed that incidence of PTLD is high in the first year post transplant(16%) and is associated with poor survival, there were substantial number of patients that were diagnosed with PTLD several years post-transplant. Median time of onset was 15 years post transplant(range 0.3-26 years). There were 25 incident episodes in the 30 year period, out of which 3 were recurrences.

Diffuse large B cell lymphoma was the most common type of PTLD and large anaplastic T cell lymphoma was the least common. In the majority of patients, site of PTLD was along the gastrointestinal tract with nodal distribution. We found the site of PTLD in extranodal sites in 3 cases involving the CNS, heart and lung. There were 7 deaths in total(33.33%) and poor survival was associated with age of recipient, number of years since transplant and type of PTLD. Long term survival post chemotherapy was high and recurrence rate was low.

Conclusions:

Patients remain at risk of developing PTLD irrespective of duration post transplant and immunosuppression. Due to varied symptoms and sites of distribution of PTLD, clinicians should have a low index of suspicion for diagnosis. Prognosis remains poor with aggressive forms although post chemotherapy survival is better.

CITATION INFORMATION: Rathore R, Tomlinson K, Dukka H, Farrugia D, Lambie M. Incidence, Recurrence and Long Term Survival Post Chemotherapy in Renal Transplant Recipients with Post Transplant Lymphoproliferative Disorder: Single Center Study. Am J Transplant. 2017;17 (suppl 3).

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