scholarly journals Epstein-Barr Virus–Related Post-Transplantation Lymphoproliferative Disorder after Unmanipulated Human Leukocyte Antigen Haploidentical Hematopoietic Stem Cell Transplantation: Incidence, Risk Factors, Treatment, and Clinical Outcomes

2015 ◽  
Vol 21 (12) ◽  
pp. 2185-2191 ◽  
Author(s):  
Lan-Ping Xu ◽  
Chun-Li Zhang ◽  
Xiao-Dong Mo ◽  
Xiao-Hui Zhang ◽  
Huan Chen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Lymphoproliferative Disorder ◽  
Epstein Barr Virus ◽  
Human Leukocyte ◽  
Post Transplantation ◽  
Hematopoietic Stem ◽  
Leukocyte Antigen ◽  
Barr Virus ◽  
Incidence Risk ◽  
Epstein Barr

Incidence, Risk Factors, Clinical Management, and Outcomes of Posttransplant Lymphoproliferative Disorder in Kidney Transplant Recipients

2019 ◽  
Vol 29 (2) ◽  
pp. 185-193 ◽  
Author(s):  
Michelle Liu ◽  
Shahid Husain ◽  
Olusegun Famure ◽  
Yanhong Li ◽  
S. Joseph Kim
Keyword(s):  
Risk Factors ◽  
Lymphoproliferative Disorder ◽  
Epstein Barr Virus ◽  
Transplant Recipients ◽  
Posttransplant Lymphoproliferative Disorder ◽  
Kidney Transplant Recipients ◽  
Barr Virus ◽  
Incidence Risk ◽  
Epstein Barr

Background: Posttransplant lymphoproliferative disorder (PTLD) is a severe complication after kidney transplantation. This study examined the incidence, risk factors, clinical management, and outcomes of PTLD in a cohort of kidney transplant recipients. Design: This single-center cohort study included 1642 patients transplanted from January 1, 2000, to December 31, 2012, with follow-up until December 31, 2013. The incidence and risk factors for PTLD were examined using a Cox proportional hazards model. A Cox model was also used to assess the association of PTLD and graft outcomes. Results: Sixteen recipients developed PTLD over follow-up. The incidence rate was 0.18 (95% confidence interval [CI]: 0.11-0.29) cases per 100 person-years. Four were from Epstein–Barr virus (EBV) mismatched (D+/R−) transplants and 12 from EBV-positive recipients (R+). Recipients with D+/R− matches were at a significantly higher risk of developing PTLD than R+ (hazard ratio [HR]: 7.52 [95% CI: 2.42-23.32]). Fifteen cases had immunosuppression reduced, 11 cases were supplemented with rituximab or ganciclovir, 6 cases required chemotherapy or radiation, and 6 cases had tumors excised. By the end of follow-up, 6 patients went into remission, 5 returned to chronic dialysis, and 5 patients died. Patients with PTLD were significantly more likely to have total graft failure (return to chronic dialysis, preemptive retransplant, or death with graft function) than patients without PTLD (HR: 3.41 [95% CI: 1.72-6.78). Discussion: Epstein–Barr virus mismatch continues to be a strong risk factor for developing PTLD after kidney transplantation. Recipients with PTLD have a poor prognosis, as the optimal management remains to be elucidated.

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