Outcomes of Post-Kidney Transplant Leukemias

B. Rouphael, A. Kukla, K. Gillingham, H. Ibrahim, A. Matas, N. Issa.

Medicine, University of Minnesota, Minneapolis, MN.

Meeting: 2015 American Transplant Congress

Abstract number: D43

Keywords: Kidney transplantation, Malignancy, Outcome

Background:

Leukemias typically portend bad prognosis in the general population. The incidence and outcomes of post-kidney transplant leukemias (PKTL) have not been well studied as most data derive from a small number of case reports.

Methods:

The incidence, prognostic factors as well as graft and patient survival in PKTL were analyzed in a large cohort of patients (n=8,381) transplanted between 1963 and 2014.

Results:

Of the 8,381 kidney transplants performed at our institution, 29 patients (0.35%) developed leukemia (acute and chronic, myelogenous and lymphocytic). All 29 patients were Caucasians and 11 out of 29 were female. The number of recipients of living donor kidneys and deceased donor kidneys were 14 and 15 respectively. 21 patients had only one kidney transplant, 7 had 2 transplants and 1 had 3 transplants. The mean time from transplantation to diagnosis of PKTL was 11.8 +/- 8.5 years. All patients died after the diagnosis of leukemia and the causes of death were: Leukemia n=23, infection n=2, cardiovascular disease n=1, GVHD n=1, and other n=2.

Multivariate analysis for death-censored graft loss showed risk factors for PKTL were the presence of leukemia (leukemia was not included as a time-dependent variable in the Cox Regression model if it occurred after graft loss) (HR=5.26, 95% CI 1.31-21.08), female gender (HR=1.12, 95% CI 1.04-1.21), deceased donor (HR=1.61, 95% CI 1.49-1.74), number of kidney transplants (HR=1.44, 95% CI 1.31-1.58) and age less than 18 years (HR=1.48, 95% CI 1.34-1.64).

Death-Censored Graft Loss

Variable	Hazard Ratio	95% Confidence Interval	P-value
Leukemia	5.26	1.31-21.08	0.0192
Female Gender	1.12	1.04-1.21	0.0019
Deceased Donor	1.61	1.49-1.74	< .0001
Number of Kidney Transplants	1.44	1.31-1.58	< .0001
Age < 18	1.48	1.34-1.64	< .0001

Risk factors for patient death were the presence of leukemia (HR=25.46, 95% CI 17.57-36.88), deceased donor (HR=1.55, 95% CI 1.45-1.65), number of kidney transplants (HR=1.31, 95% CI 1.20-1.42) and pre-transplant Diabetes Mellitus type 1 (HR=1.27, 95% CI 1.18-1.36).

Patient Death

Risk Factor	Hazard Ratio	95% Confidence Interval	P-value
Leukemia	25.46	17.57-36.88	< .0001
Deceased Donor	1.55	1.45-1.65	< .0001
Number of Kidney Transplants	1.31	1.20-1.42	< .0001
Pre-Transplant DM Type I	1.27	1.18-1.36	< .0001

Conclusion:

Leukemia is a rare disease after kidney transplantation compared to solid organ cancers, however it is associated with renal allograft loss and very high mortality.

« Back to 2015 American Transplant Congress