Comparative analysis of post-transplant lymphoproliferative disorder after kidney transplantation versus hematopoietic stem cell transplantation

Yoon, Jihyun; Lee, Seok; Kim, Hee-Je; Lee, Jong‐Wook; Min, Woo-Sung; Chung, Byung Ha; Yang, Chul Woo; Kim, Yong Soo; Kim, Ji-Il; Moon, In Sung; Oh, Eok Soo; Park, Gyeong-Sin; Cho, Seok Goo

doi:10.1111/tri.12328

Cited by 10 publications

(6 citation statements)

References 31 publications

(38 reference statements)

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“…Non-Hodgkin Lymphomas, as B-cell Lymphoma and PTLD, are common tumours after SOT [30,37]. The incidence of PTLD varies between the authors and countries and correlates with a comparable high mortality similar to the present data (Table 2) [30,43,44].…”

Section: Specific Cancers and Their Epidemiological Analysessupporting

confidence: 84%

De-novo malignancies after kidney transplantation: A long-term observational study

et al. 2020

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Background De-novo malignancies after kidney transplantation represent one major cause for mortality after transplantation. However, most of the studies are limited due to small sample size, short follow-up or lack of information about cancer specific mortality. Methods This long-term retrospective analysis included all adult patients with complete follow-up that underwent kidney transplantation between 1995 and 2016 at our centre. All patients with diagnosis of malignancy excluding non-melanoma skin cancer (NMSC) were identified and a matched control group was assigned to the kidney transplant recipients with post-transplant malignancies. Results 1417 patients matched the inclusion criteria. 179 malignancies posttransplant were diagnosed in 154 patients (n = 21 with two, n = 2 patients with three different malignancies). Mean age at cancer diagnosis was 60.3±13.3 years. Overall incidence of de-novo malignancies except NMSC was 1% per year posttransplant. Renal cell carcinoma was the most common entity (n = 49, incidence 4.20 per 1000 patient years; cancer specific mortality 12%), followed by cancer of the gastro-intestinal tract (n = 30, 2.57; 50%), urinary system (n = 24, 2.06; 13%), respiratory system (n = 18, 1.54; 89%), female reproductive system (n = 15, 1.29; 13%), posttransplant lymphoproliferative disorders and haematological tumours (n = 14, 1.20; 21%), cancers of unknown primary (n = 7, 0.60 100%) and others (n = 22, 1.89; 27%). Male sex, re-transplantation and time on dialysis were associated with de-novo malignancies after transplantation. Conclusion De-novo malignancies continue to be a serious problem after kidney transplantation. To improve long-term outcome after Kidney transplantation, prevention and cancer screening should be more tailored and intensified.

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Section: Specific Cancers and Their Epidemiological Analysessupporting

confidence: 84%

De-novo malignancies after kidney transplantation: A long-term observational study

et al. 2020

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“…A slightly higher cumulative incidence of 2.9% was reported in a Spanish cohort [11]. Similarly, the PTLD frequency described by Yoon et al [12] was 1.9%. In a larger US cohort of 156,740 kidney transplant recipients, 762 (0.5%) cases of PTLD were identified during a 20-year follow-up .…”

Section: Ptld Incidence After Kidney or Liver Transplantsupporting

confidence: 50%

Post-transplant lymphoproliferative disorders: From epidemiology to pathogenesis-driven treatment

et al. 2015

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Post-transplant lymphoproliferative disorders (PTLDs) represent the most severe complication of both solid organ and hematopoietic stem cell transplantation. The Epstein-Barr Virus (EBV) is the main driver of PTLD, particularly those occurring early after transplantation. EBV-driven malignancies are associated with selective expression of latent viral proteins, but uncontrolled lytic replication may favor early phases of cell transformation. Besides immunodepression, persistent immune activation and chronic inflammation play an important role in both virus reactivation and expansion of EBV-infected B cells. EBV-induced immortalization requires the expression of telomerase. TERT, the rate-limiting component of the telomerase complex, is central in the switch from the lytic to the latent viral program, and TERT inhibition induces the EBV lytic cycle and cell death. Immunotherapy and combination of EBV lytic cycle inducers with antiviral drugs are promising strategies to improve the treatment of PTLD patients. This review is aimed at providing an update on the intriguing association between EBV and PTLD, mainly focusing on cases arising after kidney and liver transplantation, which account for the vast majority of transplants.

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“…14 For example, immunosuppression intensity is an important determinant of the risk of post-transplant lymphoproliferative disease after kidney transplantation. [15][16][17][18][19] Studies assessing the relative risks of these agents have often been hampered by short follow-up (in the case of randomized trials), limited power (with single-center studies), or the use of registry data, which have incomplete ascertainment of malignancy outcomes and sepsis. Furthermore, healthcare resource utilization of patients following various induction therapies is poorly understood.…”

mentioning

confidence: 99%

Comparing Outcomes between Antibody Induction Therapies in Kidney Transplantation

Koyawala¹,

Silber

Rosenbaum

et al. 2017

JASN

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Kidney transplant recipients often receive antibody induction. Previous studies of induction therapy were often limited by short follow-up and/or absence of information about complications. After linking Organ Procurement and Transplantation Network data with Medicare claims, we compared outcomes between three induction therapies for kidney recipients. Using novel matching techniques developed on the basis of 15 clinical and demographic characteristics, we generated 1:1 pairs of alemtuzumab-rabbit antithymocyte globulin (rATG) (5330 pairs) and basiliximab-rATG (9378 pairs) recipients. We used paired Cox regression to analyze the primary outcomes of death and death or allograft failure. Secondary outcomes included death or sepsis, death or lymphoma, death or melanoma, and healthcare resource utilization within 1 year. Compared with rATG recipients, alemtuzumab recipients had higher risk of death (hazard ratio [HR], 1.14; 95% confidence interval [95% CI], 1.03 to 1.26; <0.01) and death or allograft failure (HR, 1.18; 95% CI, 1.09 to 1.28; <0.001). Results for death as well as death or allograft failure were generally consistent among elderly and nonelderly subgroups and among pairs receiving oral prednisone. Compared with rATG recipients, basiliximab recipients had higher risk of death (HR, 1.08; 95% CI, 1.01 to 1.16; =0.03) and death or lymphoma (HR, 1.12; 95% CI, 1.01 to 1.23; =0.03), although these differences were not confirmed in subgroup analyses. One-year resource utilization was slightly lower among alemtuzumab recipients than among rATG recipients, but did not differ between basiliximab and rATG recipients. This observational evidence indicates that, compared with alemtuzumab and basiliximab, rATG associates with lower risk of adverse outcomes, including mortality.

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Comparative analysis of post-transplant lymphoproliferative disorder after kidney transplantation versus hematopoietic stem cell transplantation

Cited by 10 publications

References 31 publications

De-novo malignancies after kidney transplantation: A long-term observational study

De-novo malignancies after kidney transplantation: A long-term observational study

Post-transplant lymphoproliferative disorders: From epidemiology to pathogenesis-driven treatment

Comparing Outcomes between Antibody Induction Therapies in Kidney Transplantation

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