A French Cohort Study of Kidney Retransplantation after Post-Transplant Lymphoproliferative Disorders

Clinical journal of the American Society of Nephrology: CJASN

Sophie Caillard¹ 

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关键词: Adult;    Antilymphocyte Serum;    Antiviral Agents;    Calcineurin;    Calcineurin Inhibitors;    Cohort Studies;    Epstein-Barr Virus Infections;    France;    Herpesvirus 4, Human;    Humans;    immunosuppression;    kidney;    kidney transplantation;    Lymphoproliferative Disorders;    Mycophenolic Acid;    Neoplasm Recurrence, Local;    Receptors, Interleukin-2;    Reoperation;    Rituximab;    thymoglobulin;   

DOI  :  10.2215/CJN.03790417

学科分类：泌尿医学

来源: American Society of Nephrology

【 摘 要 】

Background and objectives Post-transplant lymphoproliferative disorders arising after kidney transplantation portend an increased risk of morbidity and mortality. Retransplantation of patients who had developed post-transplant lymphoproliferative disorder remains questionable owing to the potential risks of recurrence when immunosuppression is reintroduced. Here, we investigated the feasibility of kidney retransplantation after the development of post-transplant lymphoproliferative disorder.Design, setting, participants, & measurements We reviewed the data from all patients who underwent kidney retransplantation after post-transplant lymphoproliferative disorder in all adult kidney transplantation centers in France between 1998 and 2015.Results We identified a total of 52 patients with kidney transplants who underwent 55 retransplantations after post-transplant lymphoproliferative disorder. The delay from post-transplant lymphoproliferative disorder to retransplantation was 100±44 months (28–224); 98% of patients were Epstein–Barr virus seropositive at the time of retransplantation. Induction therapy for retransplantation was used in 48 patients (i.e., 17 [31%] patients received thymoglobulin, and 31 [57%] patients received IL-2 receptor antagonists). Six patients were also treated with rituximab, and 53% of the patients received an antiviral drug. The association of calcineurin inhibitors, mycophenolate mofetil, and steroids was the most common maintenance immunosuppression regimen. Nine patients were switched from a calcineurin inhibitor to a mammalian target of rapamycin inhibitor. One patient developed post-transplant lymphoproliferative disorder recurrence at 24 months after retransplantation, whereas post-transplant lymphoproliferative disorder did not recur in 51 patients.Conclusions The recurrence of post-transplant lymphoproliferative disorder among patients who underwent retransplantation in France is a rare event.

【 授权许可】

CC BY