Post transplant lymphoproliferative disorder (PTLD) is the second most frequent neoplasia after renal transplantation. This life threatening disease corresponds to an uncontrolled proliferation of lymphocytes that is fostered by immunosuppression. Treatment of PTLD therefore includes, in addition to chemotherapy, a reduction of maintenance immunosuppression (RIS). PTLD patients have a 5.5 times higher rate of death-censored graft loss, underlining the urgent need for optimization of RIS strategies, which should aim not only at increasing the probability of PTLD remission but also at preserving renal graft function. In this regard, it is interesting to note that almost all published studies comparing therapeutic options for PTLD have focused on treatment efficacy rather than graft outcome.
In the present study, we retrospectively reviewed 101 cases of PTLD diagnosed in two French transplantation centers to identify the risk factors associated with renal graft loss. A particular effort was made to analyze the impact of the type of PTLD, the type of chemotherapy and the maintenance immunosuppressive regimen on kidney graft survival and the outcome of PTLD.
During the follow-up (median: 35 months, range: 1-208) 39 patients died (38.6%) and the rate of death-censored graft loss was 20.8%. Multivariate analysis, established that eGFR<30ml/min/1.73m2 at PTLD diagnosis (RR: 20.02 [2.92-137.15]; p = 0.002), biopsy-proven acute rejection episode following RIS (RR 45.36 [7.94-258.89]; p < 0.0001), and the absence of a CNI in maintenance immunosuppression (RR: 22.32 [2.94-169.07]; p = 0.002) are independent risk factors for allograft loss. Neither the type of PTLD, nor the chemotherapy regimen was predictive of allograft failure. Histological analysis of graft biopsies revealed that maintaining a CNI at reduced dose after the diagnosis of PTLD reduces the risk of humoral rejection. Remarkably, CNI maintenance was neither associated with a higher mortality, nor with a worse progression free survival.
We conclude that maintaining a CNI at reduced dose after the diagnosis of PTLD is safe and improves renal graft outcome, possibly through a better control of recipients humoral immune response.
Morelon, E.: Grant/Research Support, Cyclosporine. Thaunat, O.: Grant/Research Support, Cyclosporine.
To cite this abstract in AMA style:Morelon E, Serre J, Michonneau D, Bachy E, Noel L, Kreis H, Legendre C, Mamzer M, Thaunat O. Maintaining a Calcineurin-Inhibitor after the Diagnosis of PTLD Is Safe and Improves Renal Graft Survival [abstract]. Am J Transplant. 2013; 13 (suppl 5). https://atcmeetingabstracts.com/abstract/maintaining-a-calcineurin-inhibitor-after-the-diagnosis-of-ptld-is-safe-and-improves-renal-graft-survival/. Accessed October 22, 2020.
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