Abstract: SA-PO519

The Incidence and Predictors of Post-Transplant Lymphoproliferative Disease (PTLD) after Kidney Transplantation

Session Information

Category: Transplantation

  • 1702 Transplantation: Clinical and Translational

Authors

  • Francis, Anna, University of Sydney, Sydney, New South Wales, Australia
  • Johnson, David W., Princess Alexandra Hospital, Brisbane, Queensland, Australia
  • Craig, Jonathan C., University of Sydney/Children's Hospital, Sydney, New South Wales, Australia
  • Wong, Germaine, None, Auambie, New South Wales, Australia
Background

PTLD is well described, but the long-term incidences and risk factors for PTLD for adult and paediatric renal transplant recipients remain unclear.

Methods

Using data from the Australian and New Zealand Dialysis and Transplant Registry (1963-2015), the cumulative incidence of PTLD in all kidney transplant recipients was calculated using a competing risk of death model and compared with age-matched population-based data using standardized incidence ratios (SIR). Risk factors for PTLD in the modern era of immunosuppression (from year 2000) were assessed using competing risk Cox regression.

Results

Among 23, 477 patients (92% adult, 60% male) followed for a median time of 8.5 years, 505 developed PTLD with 50/505 occurring in childhood (age at transplant under 20 years) recipients. The 25-year cumulative incidence of PTLD was 3.3% (95%CI 2.9-3.6%) for adult recipients and 3.6% (95%CI 2.7-4.8%) for child recipients (figure 1). Childhood transplant recipients had a 30-fold increased risk of developing lymphoma compared to the general population (SIR 29.5, 95%CI 21.9-38.8), higher than for adult transplant recipients (SIR 8.4, 95%CI 7.7-9.2). EBV negative recipient serology (adjusted hazard ratio [aHR] 2.85, 95%CI 1.69-4.81), year of transplantation (aHR 0.89 for each year after the year 2000, 95%CI 0.82-0.95) and having diabetes (aHR 2.53, 95%CI 1.37-4.67) were independently associated with PTLD, when adjusted for race, gender, age group and induction agent.

Conclusion

Lymphoproliferative disease in transplant recipients occurs at higher rates than in the general population, particularly in paediatric recipients. EBV-negative patients and those with diabetes are at increased risk of PTLD, however PTLD rates have been decreasing over the last 15 years.

Cumulative incidence of PTLD post kidney transplantation

Funding

  • Private Foundation Support