Successful Renal Retransplantation after Post-Transplant Lymphoproliferative Disease

Abstract

Post-transplant lymphoproliferative disease (PTLD) is a rare but severe complication of renal transplantation. Reduction of immunosuppression is essential for controlling PTLD but may induce graft loss. Retransplantation after PTLD is considered dangerous, because immunosuppressive treatment resumption may trigger hematological relapse. We retrospectively report six patients (five adults, one child) who underwent a second renal transplantation after successfully treated PTLD.Epstein-Barr virus (EBV) serology was positive before the first transplantation in all patients except the child. Post-transplant lymphoproliferative disease was detected 6.6 months (range 4.5-9.4) after transplantation. Lymphoproliferation was always monomorphic, B-cell, and EBV-related. Post-transplant lymphoproliferative disease was confined to the renal allograft (n = 4), multilocular (n = 1) or cerebral (n = 1). Immunosuppression tapering (6/6) and transplantectomy (5/6) led to hematological remission in all patients.Retransplantation was performed 77 months (range 50-128) after PTLD diagnosis. Immunosuppression included steroids (n = 6), ATG (n = 2), anti-CD25 (n = 2), cyclosporine (n = 4), tacrolimus (n = 2), mycophenolate mofetil (n = 4) and azathioprine (n = 1). After a median follow up of 30 months (range 24-47) patient survival was 100%, with no recurrence of PTLD.In conclusion, renal retransplantation can be considered in patients with monomorphic PTLD history, without major risk of hematological recurrence.

Outcomes of kidney retransplantation in recipients with prior post‐transplant lymphoproliferative disorder

“…Six/six patients had their immunosuppression lowered and five/six underwent graft nephrectomy as part of PTLD treatment. Complete remission was achieved in all six patients at least two yr before consideration for kidney retransplantation . There were no cases of clinical recurrence after a median follow‐up of 30 months.…”

Improved Survival with Recent Post-Transplant Lymphoproliferative Disorder (PTLD) in Children with Kidney Transplants

“…The few series looking at results of retransplantation after PTLD in a prior allograft did not report any recurrence of PTLD (27)(28)(29).…”

Management of post‐transplant lymphoproliferative disorder in adult solid organ transplant recipients – BCSH and BTS Guidelines

“…However, a period of at the very least 1 year seems appropriate. A recent survey of French transplant centres (Karras et al , 2004) identified a series of six patients with PTLD, including four in whom the disease was confined to the kidney transplant. After successful treatment (which in all cases involved transplant nephrectomy) re‐transplantation was undertaken between 50 and 128 months after diagnosis of PTLD and 29–97 months (mean 46 months) after graft nephrectomy.…”