PTLD is a serious and potentially fatal complication of solid organ transplantation (Tx). It represents a spectrum of tumors ranging from benign lymphoid proliferation to malignant monomorphic ß-cell lymphoma that is associated with high mortality. ReTx requires resumption of immunosuppression (IS) that may incresase PTLD relapse risk. We retrospectively reviewed 8 pediatric/adult kidney transplant patients who underwent reTx after diagnosis of PTLD following 1^st kidney Tx.

PTLD was diagnosed after a median of 62.5 mos (range 5-323 mos) post-1^st kidney Tx. EBV sero-status was unknown before the 1^st Tx in all patients and was positive in 6/8 patients (1 negative, 1 missing-data) before reTx. PTLD involved the allograft (n=1), lymph-nodes (n=2) or central nervous system (n=1), GI tract (n=4). In-situ EBV positivity was detected in all 8 patients. IS was reduced/withdrawn in all 8 and (n=6) received chemotherapy. Allograft nephrectomy was done in (n =1) patient. All 8 patients were deemed cured from PTLD before reTx. Renal reTx was performed after a median of 55.5 mos (range 29–95 mos) after PTLD diagnosis. Median age at reTx was 22 yrs (range 7-75 yrs); 7/8 were males, and 7/8 were Caucasian. IS included: Induction: Thymoglobulin (n=5), basiliximab in (n=1) and missing data in (n=2); and maintenance IS included:cyclosporine (n=3), tacrolimus (n=5), mycophenolate mofetil (n=7) and azathioprine (n=1). After a median follow-up of 62.5 mos (range 2–125 mos) post reTx, allogarft and patient survivals were 87.5% (n=7 functioning grafts, n=1 failed from chronic rejection) and 62.5 % (n=5 living, n=3 dead) with no recurrence of PTLD. The causes of death (n =3/8) were attributed to a different cause and not to PTLD recurrence (n=2 from GI bleed, n=1 from peritonitis). In conclusion, kidney reTx can be safely achieved in patients with prior PTLD history and does not affect allograft and patient survival provided that patients had remission of the PTLD.

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