COMPLICATIONS - MALIGNANCY

A. Franco, L. Jimenez, C. Sillero, P. Mas, M. Trigueros, J. Olivares
Nephrology, hospital general alicante, alicante/SPAIN

Body: Post-transplant lymphoproliferative disorders (PTLD) are a group of heterogeneous lymphoid proliferations in chronic immunosuppressed recipients which appear to be related to Epstein Barr Virus (EBV). EBV seronegativity in the receptor, the use of antilymphocyte antibodies, acute rejection due to the increase of high doses of steroids and CMV disease have been identified as classical risk factors We have studied the incidence of PTLD and its relationship with EBV in 1117 adult renal transplant recipients from cadaveric donors, who were transplanted in our hospital from 1988 to 2010. We have also evaluated the possible variation of PTLD incidence in 2 decades, the risk factors and the outcome of the patients who developed PTLD. All patients received immunosuppression with calcineurin inhibitors, prednisone and azathioprine, switched to MMF since 1998. Immunological risk recipients were treated with antilymphocyte antibodies. PTLD was always diagnosed histologically and EBV determined in proliferative cells by hibridation in situ. Two different periods were analized:1988-1999 and 2000-2009 with 558 recipients in each group.The follow-up was at least 6 months (range 6- 255). We identified 27 recipients (21 males and 6 females), aged 18 to 70 years (mean age 45.6 ±15.3) with a time between grafting and PTLD of 72.8 ± 56.3 months (1-180), who developed PTLD (2.4%).The odd ratio (IC 95%) of the period 1988-1999 vs 2000-2009 was 0,31 (0,14-0,67), so that the posibilitity of PTLD in the recipients of this period is increased in 31% ,but the time of risk was far more longer. Six patients CD20 positive were treated with rituximab. Thirteen out of 27 recipients (48,1%) had no classical risk factor and only 4 patients more than one. The presence of EBV in the limphoproliferative cells was confirmed in 18 out of the 25 studied recipients (72%). The patient and graft survivals were 29,6% and 11,5% at 2 years. There was no significant difference in the survival of patients treated with rituximab In conclusion, PTLD is a frequent disease with a poor prognosis in renal transplant patiens. It seems to have a close relationship with EBV and can develop in the absence of the classical risk factors. The incidence of PTLD could have been decreasing the last decade, but time is needed to confirm it.

Disclosure: All authors have declared no conflicts of interest.