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Abstract: FR-PO863

Utility of Immunoglobulin/T-Cell Receptor Gene Rearrangements As a Tool for Early Detection and Monitoring of Post-Transplant Lymphoproliferative Disorder in Renal Transplant Recipients

Session Information

  • Transplantation: Basic
    October 26, 2018 | Location: Exhibit Hall, San Diego Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Transplantation

  • 1801 Transplantation: Basic

Authors

  • Yeo, Wee Song, National University of Singapore, Singapore, Singapore
  • Chan, Chang-Yien, National University of Singapore, Singapore, Singapore
  • Yap, Hui Kim, National University Hospital, Singapore, Singapore
Introduction

Post-transplant lymphoproliferative disorder (PTLD) is a well-known complication post-transplant and contributes significantly to the morbidity and mortality seen in transplant recipients. A key limitation in the management of this dreaded disease involves its early detection and subsequent monitoring. A potential solution involves Ig/TCR gene rearrangement analysis. This molecular clonality analysis technique is based on the principle that, all cells of a malignancy have a common clonal origin and demonstrate clonally rearranged Ig or TCR genes. The diagnosis of malignant B- and T-cell proliferations is therefore supported by the finding of Ig/TCR gene clonality, whereas reactive lymphoproliferations show polyclonally rearranged Ig/TCR genes. We report our experience with two renal transplant recipients with PTLD whereby Ig/TCR gene rearrangements may play a role in the surveillance of this lymphoproliferative disorder.

Case Description

The 2 patients reported underwent cadaveric renal transplantation with subsequent development of PTLD. Both had reduction in immunosuppressants with rituximab therapy, following diagnosis of PTLD. One of the patients went on to CHOP chemotherapy and even lost her renal allograft secondary to PTLD involvement. Both patients were in clinical, hematological and radiological (PET scan) remission at the point of performance of Ig/TCR gene rearrangements. In these two pediatric renal transplant recipients with PTLD, it was noticed that there were Ig/TCR gene rearrangements detectable in their peripheral blood suggestive of clonal remnant of their PTLD.

Discussion

Lymph node/tissue biopsies remain the gold standard for the diagnosis of PTLD. Transplant recipients could not and should not be subjected to infinite repeated biopsies or expensive imaging studies (e.g. PET-CT scans) for the purpose of monitoring for the development of PTLD in view of inherent risks associated with biopsies and radiation risks, respectively. Our case report suggests the potential utility of Ig/TCR gene rearrangements as a non-invasive tool for early detection and monitoring of PTLD. Further large prospective trials are required to validate the above proposal.