Post-Transplant Lymphoproliferative Disorder (PLTD) is a well-recognised serious complication in renal transplant recipients. Induction with lymphocyte depleting agents such as thymoglobulin has been associated with a higher incidence of PTLD. In this study we report the incidence, nature and outcome of PTLD post Alemtuzumab induction in renal transplantation.

We retrospectively reviewed the medical records of 946 (608m, 338f, mean age 54.1years) renal transplant recipients in our centre between November 2005 and October 2013 for the occurrence of histologically proven PTLD. All patients received a steroid sparing immunosuppressive regimen with Alemtuzumab and Tacrolimus (Tac) monotherapy. Steroids and Mycophenolate Mofetil (MMF) were only introduced to treat rejection.

Patient and graft survival at 5 years was 91.1% and 86.7% respectively. 10 out of 946 (1.06%) patients developed PTLD (10m, 0f, mean age 52.2 years). These included 6 B-cell lymphomas, 1 T-cell lymphoma and 3 plasmacytoma-like lymphomas. 8 out of 10 were CD20 positive and 3 out of 10 were EBV positive. Mean follow-up was 5.9 years and mean time from Alemtuzumab exposure to diagnosis of PTLD was 3.9 years (0.9 – 8.0 years). None of the patients had previously received Alemtuzumab or myeloablative therapy for their underlying primary renal disease. 4 out of 10 had received steroids, MMF and Tac for treatment of rejection prior to diagnosis and no recipient developed rejection post PTLD. Treatment was complex; patients with B-cell and T-cell lymphomas received a Rituximab based chemotherapy while those with plasmacytoma-like lymphomas received a Velcade based regimen. Current patient and graft survival is 90% and 80% respectively; 1 patient died following relapse of PTLD and 1 graft was lost from recurrent disease ( immune complex GN).

This study showed that Alemtuzumab is not associated with an increased rate of PTLD and outcome after appropriate treatment is favourable.

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