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.
Keywords: Adult; Antilymphocyte Serum; Antiviral Agents; Calcineurin; Calcineurin Inhibitors; Cohort Studies; Epstein-Barr Virus Infections; France; Herpesvirus 4, Human; Humans; Lymphoproliferative Disorders; Mycophenolic Acid; Neoplasm Recurrence, Local; Receptors, Interleukin-2; Reoperation; Rituximab; immunosuppression; kidney; kidney transplantation; thymoglobulin.
Copyright © 2017 by the American Society of Nephrology.