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Abstract
Post-transplant lymphoproliferative disorder (PTLD) is a rare, serious complication following solid organ transplantation, with an incidence of 2.6 cases per 1000 patient years. Optimal treatment strategies and risk stratifications specific to kidney transplantation are lacking and PTLD mortality remains high. This study investigated survival and prognosis in 89 cases of PTLD presenting over 44 years at Manchester Royal Infirmary. Patient survival following diagnosis was 72% at 6 months, 67% at 1 year and 54% at 3 years. In multivariate analysis, a poorer 3 year survival was associated with acute kidney injury at diagnosis (p = 0.0001), impaired renal function (p = 0.04), early onset (p = 0.02), T cell disease (p = 0.02) and previous treatment with anti-thymocyte globulin (p = 0.04). The inclusion of graft function adds prognostic value to risk stratification and should be explored further. Strategies to improve survival should include timing and choice of immuno-chemotherapy, preparation for dialysis and aggressive surveillance for sepsis and treatment toxicity.
Acknowledgments
Drs Susan Martin and Judith Worthington obtained sera from Tissue Typing. Victoria Bowman provided the MRI transplant database. Will Hulme at NHS Blood and Transplant. Stephanie Johnson and Kate Atkinson provided research support. Professor Philip Kalra at Salford Royal Foundation Trust and Dr Laurie Solomon at Royal Preston Hospital and staff reviewed PTLD in recipients returned to their hospitals. MM received an Astellas Renal Transplant Clinical Fellowship. MP received an unrestricted educational grant from Amgen. Funding support was provided by Central Manchester University Hospital Foundation Trust Biomedical Research Centre as research grants awarded in open competition.
Potential conflict of interest
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