Lymphomas After Solid Organ Transplantation: A Collaborative Transplant Study Report

Abstract

We used the Collaborative Transplant Study database to analyze the incidence, risk, and impact of malignant lymphomas in approximately 200 000 organ transplant recipients. Over a 10-year period, the risk in renal transplant recipients was 11.8-fold higher than that in a matched nontransplanted population (p < < 0.0001). The majority of lymphomas were diagnosed after the first post-transplant year. Heart-lung transplants showed the highest relative risk (RR 239.5) among different types of organ transplants. In kidney recipients, immunosuppression with cyclosporine did not confer added risk compared with azathioprine/steroid treatment, whereas treatment with FK506 increased the risk approximately twofold. Induction therapy with OKT3 or ATG, but not with anti-IL2 receptor antibodies, increased the risk of lymphoma during the first year. Antirejection therapy with OKT3 or ATG also increased the risk. First-year mortality in renal and heart transplant patients with lymphoma was approximately 40% and 50%, respectively, and showed no improvement in recent years. A pattern of preferential localization to the vicinity of the transplant was noted, and the prognosis of the patient was related to localization. This study highlights the continuing risk for lymphoma with time post-transplantation, the contribution of immunosuppression to increased risk, and continuing poor outcomes in patients with post-transplant lymphoma.

Cancer in the Transplant Recipient

“…In general, kidney cancer risk is greatest for kidney recipients (increased approximately eightfold), and similarly, risk of lung cancer is highest for lung recipients (approximately fivefold risk), and liver cancer for liver recipients (although here, given that liver cancer is an indication for liver transplantation, interpretation is not straightforward). Risk of non-Hodgkins lymphoma, or posttransplant lymphoproliferative disease (PTLD), is elevated by .5 times for all organ recipients, but the magnitude of risk is by far the greatest for lung and heart recipients compared with those who receive other solid organs (Table 5) (Opelz and Döhler 2004). …”

“…PTLD may arise in donor tissue, and it is not uncommon for PTLD to arise in proximity to the transplanted organ. Recipients of kidney transplants are more likely to get renal lymphoma than recipients of heart transplants; similarly heart transplant recipients more commonly get cardiac or thoracic PTLD than kidney recipients (Opelz and Döhler 2004).…”

Management of post-transplant Epstein-Barr virus-related lymphoproliferative disease in solid organ and hematopoietic stem cell recipients

“…An intact immune system can control this infection, through either B-cell apoptosis, or cytotoxic T-cell activity. However, in the presence of post-transplant immunosuppression, immune control ceases to be effective and there is a risk of lymphoproliferative disease development 1 . Although all cases of post-transplant lymphoproliferative disease (PTLD) are not caused by EBV, EBV-related PTLD is one of the main complications associated with relevant morbidity and mortality in solid organ transplant recipients.…”

“…Analysis of records from a database of 200,000 solid organs transplantations, at 271 centers in 42 European countries, showed that the frequency of EBV-related PTLD is highest for heartlung transplantation (42.7%), followed by the liver (21.8%), heart (16%), and kidney (10.3%) 1 . Mortality due to EBV-related PTLD is also high, ranging from 25% to 48%, and is more frequent in patients who develop PTLD in the fi rst six months post-transplant 8 .…”

Posttransplant Malignancies in Renal Transplant Recipients: 22-years Experience from a Single Center in Pakistan

“…In kidney transplantation, the risk for PTLD was found to be about 40 times greater than in the general population (Pen, 1998;Pen, 2000;Kasiske et al, 2004 a significantly high morbidity and mortality rate, as evidenced by literature, which shows that death occurs in more than 50% of patients (Opelz and Dohler, 2004). Hence, an early diagnosis and treatment of posttransplant malignancies is important.…”