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

Autor: Caillard S; Due to the number of contributing authors, the affiliations are provided in the Supplemental Material ., Cellot E, Dantal J, Thaunat O, Provot F, Janbon B, Buchler M, Anglicheau D, Merville P, Lang P, Frimat L, Colosio C, Alamartine E, Kamar N, Heng AE, Durrbach A, Moal V, Rivalan J, Etienne I, Peraldi MN, Moreau A, Moulin B
Jazyk: angličtina
Zdroj: Clinical journal of the American Society of Nephrology : CJASN [Clin J Am Soc Nephrol] 2017 Oct 06; Vol. 12 (10), pp. 1663-1670. Date of Electronic Publication: 2017 Aug 17.
DOI: 10.2215/CJN.03790417
Abstrakt: 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.
(Copyright © 2017 by the American Society of Nephrology.)
Databáze: MEDLINE