A French Cohort Study of Kidney Retransplantation after Post-Transplant Lymphoproliferative Disorders

[摘要] Background and objectives Post-transplant lymphoproliferative disorders arising after kidney transplantation portend an increased risk of morbidity and mortality. Retransplantation of patients who had developed post-transplant lymphoproliferative disorder remains questionable owing to the potential risks of recurrence when immunosuppression is reintroduced. Here, we investigated the feasibility of kidney retransplantation after the development of post-transplant lymphoproliferative disorder.Design, setting, participants, & measurements We reviewed the data from all patients who underwent kidney retransplantation after post-transplant lymphoproliferative disorder in all adult kidney transplantation centers in France between 1998 and 2015.Results We identified a total of 52 patients with kidney transplants who underwent 55 retransplantations after post-transplant lymphoproliferative disorder. The delay from post-transplant lymphoproliferative disorder to retransplantation was 100±44 months (28–224); 98% of patients were Epstein–Barr virus seropositive at the time of retransplantation. Induction therapy for retransplantation was used in 48 patients (i.e., 17 [31%] patients received thymoglobulin, and 31 [57%] patients received IL-2 receptor antagonists). Six patients were also treated with rituximab, and 53% of the patients received an antiviral drug. The association of calcineurin inhibitors, mycophenolate mofetil, and steroids was the most common maintenance immunosuppression regimen. Nine patients were switched from a calcineurin inhibitor to a mammalian target of rapamycin inhibitor. One patient developed post-transplant lymphoproliferative disorder recurrence at 24 months after retransplantation, whereas post-transplant lymphoproliferative disorder did not recur in 51 patients.Conclusions The recurrence of post-transplant lymphoproliferative disorder among patients who underwent retransplantation in France is a rare event.

[学科分类] 泌尿医学

[关键词] Adult;Antilymphocyte Serum;Antiviral Agents;Calcineurin;Calcineurin Inhibitors;Cohort Studies;Epstein-Barr Virus Infections;France;Herpesvirus 4, Human;Humans;immunosuppression;kidney;kidney transplantation;Lymphoproliferative Disorders;Mycophenolic Acid;Neoplasm Recurrence, Local;Receptors, Interleukin-2;Reoperation;Rituximab;thymoglobulin