Post-Transplant Lymphoproliferative Disorder in Kidney and Simultaneous Pancreas and Kidney Transplant Recipients Predictors, and Patient and Allograft Outcomes
1Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, 2Medicine-Transplant Nephrology, University of Wisconsin School of Medicine and Public Health, Madison, WI, 3University of Wsiconsin, Madison, WI, 4University of Wisconsin, Madison, WI, 5UW Health, Madison, WI
Meeting: 2022 American Transplant Congress
Abstract number: 1014
Keywords: Donation, Kidney/pancreas transplantation, Lymphoproliferative disease, Outcome
Topic: Clinical Science » Infection Disease » 28 - PTLD: All Topics
Session Information
Session Time: 7:00pm-8:00pm
Presentation Time: 7:00pm-8:00pm
Location: Hynes Halls C & D
*Purpose: Post-transplant lymphoproliferative disorder (PTLD) is a devastating complication following kidney and pancreas transplantation. 12% of UNOS waitlisted candidates had previous transplant and 20% are highly sensitized. Reduction of immunosuppression has been the main stay in theraputic approach. Identifying modifiable predictors may reduce the incidence rate among the highly sensitized patients. This analysis examine PTLD predictors, patients and allograft outcomes in the last decade.
*Methods: We analyzed all adult Kidney and Simultaneous Pancreas and Kidney (SPK) transplants who developed PTLD between 2010 and 2020 using a nested case-control design. Cases of PTLD were matched to 5 controls using incidence density sampling, matched on transplant year and type of transplant (kidney or SPK). Baseline characteristics were compared between cases and controls, as were post-PTLD outcomes
*Results: Total of 78 cases of PTLD (SPK n= 12) and 387 control were identified during the study period. Transplants were completed 1994 to 2018. D+/R- EBV serostatus (odds ratio [OR]: 8.28; 95% CI: 2.96-23.14; p <0.001) and prior transplant (OR: 1.93: 95% CI: 1.11-3.36; p 0.02) were significantly associated with increased risk of PTLD, Table 1. Cases and controls did not differ in terms of age at transplant, induction, maintenance, HLA mismatches greater > 3 or prior rejection. Risk of death with a functioning graft (DWFG) was significantly higher among recipients with PTLD than controls (hazard ratio [HR]: 2.21; 95% CI: 1.43-3.43; p <0.001), whereas the risk of rejection and graft failure did not differ. Total graft loss was significantly higher in the PTLD group (HR: 1.63; 95% CI: 1.14-2.35; p 0.007).
*Conclusions: EBV D+/R- serostatus and prior transplant are significantly associated with increased risk of PTLD. The occurrence of PTLD is associated with a two-fold increased risk of DWFG, but no significant difference in the rejection or graft failure. Promoting living donation and expanding the national exchange program may improve HLA and perhaps EBV-matching, with potential subsequent reduction in immunosuppression potency, incidence of PTLD and it’s associated poor outcomes.
| N=465 | Odd Ratio
(95%CI)
P
|
|
| Malignancy | ||
| Prior Transplant | 1.93 (1.11-3.36) 0.02 | |
| EBV D+/R- | 8.28 (2.96-23.14) <0.001 | |
| Induction | Thymoglobulin | Reference |
| Basliximab | 0.87 (0.47-1.62) | |
| Campath | 0.98 (0.54-1.78) | |
| HLA>3 | 1.02 (0.62-1.68) 0.93 |
To cite this abstract in AMA style:
Mohamed MA, Yousif EA, Manchala V, Aziz F, Garg N, Parajuli S, Mandelbrot D, Astor B. Post-Transplant Lymphoproliferative Disorder in Kidney and Simultaneous Pancreas and Kidney Transplant Recipients Predictors, and Patient and Allograft Outcomes [abstract]. Am J Transplant. 2022; 22 (suppl 3). https://atcmeetingabstracts.com/abstract/post-transplant-lymphoproliferative-disorder-in-kidney-and-simultaneous-pancreas-and-kidney-transplant-recipients-predictors-and-patient-and-allograft-outcomes/. Accessed November 21, 2024.« Back to 2022 American Transplant Congress