Improved Survival with Recent Post‐Transplant Lymphoproliferative Disorder (PTLD) in Children with Kidney Transplants

• Published in: American journal of transplantation Vol. 11; no. 4; pp. 751 - 758
• Main Authors: Dharnidharka, V. R., Martz, K. L., Stablein, D. M., Benfield, M. R.
• Format: Journal Article
• Language: English
• Published: Malden, USA Blackwell Publishing Inc 01.04.2011; Wiley
• Subjects: Adolescent; Biological and medical sciences; Child; Child, Preschool; Female; General aspects; Graft Survival; Hematologic and hematopoietic diseases; Humans; Infant; Infant, Newborn; Kidney transplant; Kidney Transplantation - adverse effects; Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis; Lymphoproliferative Disorders - etiology; Lymphoproliferative Disorders - mortality; Male; Medical sciences; pediatric; Postoperative Complications; post‐transplant lymphoproliferative disorder; Retrospective Studies; Risk Factors; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surveys and Questionnaires; Survival Rate; Treatment Outcome; Human; Pediatrics; Prognosis; post-transplant lymphoproliferative disorder; Hemopathy; Transplantation; Homotransplantation; Survival; Kidney; pediatric; Treatment; Urinary system; Kidney transplant; Posttransplant lymphoproliferative disorder; Surgery; Lymphoproliferative syndrome; Graft; Child
• ISSN: 1600-6135; 1600-6143
• DOI: 10.1111/j.1600-6143.2011.03470.x

Post‐transplant lymphoproliferative disorder (PTLD) has been associated with high mortality, but recent anecdotal survival appeared better. From 1988 to 2010, the NAPRTCS registry had 235 registered PTLD cases. We sent a special 25‐point questionnaire study to the NAPRTCS centers with the most recent 150 cases to obtain additional follow‐up data not collected in the master registry, our objective being to determine the recent outcomes after PTLD and determine prognostic factors. We received 92 completed responses, in which only 12 (13%) deaths were reported, 2 from nonmedical causes, 10 with a functioning graft. Kaplan–Meier‐calculated patient survival was 90.6% at 1 year and 87.4% at 3, 4 and 5 years post‐PTLD. Graft survival post‐PTLD was 81.8% at 1 year, 68.0% at 3 years and 65.0% at 5 years. Seven patients received a retransplant after PTLD, with no PTLD recurrence reported. Using all 235 PTLD cases, the covariates associated with better patient survival were more recent year of PTLD diagnosis (adjusted hazard ratio AHR 0.86, p < 0.001), and with worse survival were late PTLD (AHR 1.98, p = 0.0176) and patient age above 13 at PTLD (AHR 3.43, p value 0.022). In children with kidney transplants, patient survival has improved with more recent PTLDs. This study demonstrates improved patient survival in more recent cases of posttransplant lymphoproliferative disease cases, with relatively worse survival in cases that occurred beyond 1 year postransplant or in older children.