COMPLICATIONS - MALIGNANCY

A. Kaul
Nephrology, sgpgims,lucknow,india, lucknow/INDIA

Body: introduction-The development of post transplant lymphoproliferative disorder is a well recognized complication of solid organ transplantation in patients receiving immunosuppressive medication. Present study tries to look for association ,type of immunosupression and other related parameters in the occurance of PTLD in our group of live related transplant . methods-A retrospective analysis of our medical records of all 1792 live related renal transplant recipients done till December 2008 was conducted at Sanjay Gandhi post graduate institute of medical sciences ,Lucknow ,India.The type of immunosupression ,any rejection and treatment offered ,post transplant follow up period was thoroughly analysed .Symptoms and signs prior to diagnosis were noted ,treatment and subsequent follow up and outcome was assessed. results-15 out of 1792were diagnosed to have PTLD till 2008.Median age was 45 years( range 28-59 years).Males were 15.Average period from transplant to diagnosis was 8.7 years -they all were late PTLD. Most common presentation was fever with abdominal lump. Histological diagnosis were based on 7 from resected specimens. Morphologically all except 1 case displayed monomorphic population of atypical large lymphoid cells.11 showed cd20 positivity while 2 showed cd3 postivity.6 patients had bone marrow specimens of which 1 showed lymphomatous infilteration.1 of the patients was diagnosed through FNAC of the liver showing lymphoid cells. Immunosupression was modified in 10 ,4 were changed to sirolimus and steroids while 6 were put on steroids and cyclosporine.however inspite of reduction in immunosupression and treatment for the PTLD we were unable to salvage them . Acyclovir was given in 15 cases.11 received treatment with chemotherapy with immunosupression modification.Median follow up post diagnosis was 5 months(2-24 months).All patients died on follow up . 3 pateint showed reoccurance of disease while 1 showed dissemination .All had graft dysfunction 2 of them required dialysis. In the light of discussion preventation appears to be the best therapeutic approach in PTLD .conclusion-This might include donor/recipient matching to exclude primary EBV infection ,induction of immunity in seronegative patients with vaccination .Immunosupressive antirejection treatment when necessary should be used with minimal requesite dose

Disclosure: All authors have declared no conflicts of interest.