Post-Transplantation Lymphoproliferative Disorder After Kidney Transplantation: Report of a Nationwide French Registry and the Development of a New Prognostic Score

• DOI: 10.1200/jco.2012.43.2344
• Publication Date: 2013-02-20T02:32:25Z
• Authors: Sophie Caillard; Raphael Porcher; François Provot; Jacques Dantal; Sylvain Choquet; Antoine Durrbach; Emmanuel Morelon; Valérie Moal; Benedicte Janbon; Eric Alamartine; Claire Pouteil Noble; Delphine Morel; Nassim Kamar; Matthias Buchler; Marie France Mamzer; Marie Noelle Peraldi; Christian Hiesse; Edith Renoult; Olivier Toupance; Jean Philippe Rer...; Sylvie Delmas; Philippe Lang; Yvon Lebranchu; Anne Elisabeth Heng; Jean Michel Rebibou; Christiane Mousson; Denis Glotz; Joseph Rivalan; Antoine Thierry; Isabelle Etienne; Marie Christine Moal; Laetitia Albano; Jean François Subra; Nacera Ouali; Pierre François W...; Michel Delahousse; Robert Genin; Bruno Hurault de ...; Bruno Moulin
• Keywords: Adult; Male; MESH: Registries; Adolescent; 610; MESH: Multivariate Analysis; MESH: Prognosis; MESH: Kidney Transplantation; Young Adult; 03 medical and health sciences; MESH: Lymphoproliferative Disorders; Postoperative Complications; 0302 clinical medicine; MESH: Risk Factors; Risk Factors; MESH: Postoperative Complications; 616; Humans; Prospective Studies; Registries; Aged; MESH: Adolescent; MESH: Aged; MESH: Middle Aged; MESH: Humans; MESH: Adult; MESH: Follow-Up Studies; [SDV.SP]Life Sciences [q-bio]/Pharmaceutical sciences; Middle Aged; Prognosis; Kidney Transplantation; Survival Analysis; MESH: Prospective Studies; MESH: Male; Lymphoproliferative Disorders; 3. Good health; MESH: France; [SDV.SP] Life Sciences [q-bio]/Pharmaceutical sciences; MESH: Young Adult; MESH: Survival Analysis; Multivariate Analysis; Female; France; MESH: Female; Follow-Up Studies

Purpose Post-transplantation lymphoproliferative disorder (PTLD) is associated with significant mortality in kidney transplant recipients. We conducted a prospective survey of the occurrence of PTLD in a French nationwide population of adult kidney recipients over 10 years. Patients and Methods A French registry was established to cover a nationwide population of transplant recipients and prospectively enroll all adult kidney recipients who developed PTLD between January 1, 1998, and December 31, 2007. Five hundred patient cases of PTLD were referred to the French registry. The prognostic factors for PTLD were investigated using Kaplan-Meier and Cox analyses. Results Patients with PTLD had a 5-year survival rate of 53% and 10-year survival rate of 45%. Multivariable analyses revealed that age > 55 years, serum creatinine level > 133 μmol/L, elevated lactate dehydrogenase levels, disseminated lymphoma, brain localization, invasion of serous membranes, monomorphic PTLD, and T-cell PTLD were independent prognostic indicators of poor survival. Considering five variables at diagnosis (age, serum creatinine, lactate dehydrogenase, PTLD localization, and histology), we constructed a prognostic score that classified patients with PTLD as being at low, moderate, high, or very high risk for death. The 10-year survival rate was 85% for low-, 80% for moderate-, 56% for high-, and 0% for very high–risk recipients. Conclusion This nationwide study highlights the prognostic factors for PTLD and enables the development of a new prognostic score. After validation in an independent cohort, the use of this score should allow treatment strategies to be better tailored to individual patients in the future.