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Kidney Week

Abstract: PO2222

Heterogeneous Manifestations of Post-Renal Transplant Lymphoma

Session Information

  • Onco-Nephrology - 2
    October 22, 2020 | Location: On-Demand
    Abstract Time: 10:00 AM - 12:00 PM

Category: Trainee Case Report

  • 1500 Onco-Nephrology

Authors

  • Patil, Rujuta R., Wayne State University School of Medicine, Detroit, Michigan, United States
  • Abouljoud, M., Henry Ford Hospital, Detroit, Michigan, United States
  • Patel, Anita K., Henry Ford Hospital, Detroit, Michigan, United States
Introduction

Post-transplant lymphoproliferative disorder (PTLD) is a serious complication occurring in 1-3% of adult renal transplant recipients (RTR). PTLD is often associated with Epstein-Barr Virus (EBV) and over immunosuppression (IS). A majority of PTLD is of B-cell origin. PTLD has a heterogenous presentation, involving the allograft, GI tract, and nervous system. We present a case series of 16 RTR who demonstrate a variety of PTLD manifestations.

Case Description

50% of RTR were Caucasian and 38% African American. 62% of RTR received a deceased donor and 38% a living donor. 62% received Thymoglobulin induction and 38% Simulect. Maintenance IS was Prednisone, Tacrolimus, and Mycophenolate Mofetil (MMF).
RTR presented with GI symptoms, abdominal pain, B symptoms, and neurological deficits. At diagnosis, average time from transplantation was 96.8 months (<1-20 years); 56% of RTR were <60 years old and 44% were >61years old. 31% were EBV mismatched and 12.5% were Cytomegalovirus mismatched.

PTLD involved a single site in 44% and multiple sites in 56%. PTLD localized to the GI tract (10), lymph nodes (9), CNS (4), bone marrow (3), lungs (2), mediastinum (2), skin (2), retroperitoneum (1), and native kidney/ureter (2). 6 RTR had purely extranodal involvement. PTLD was EBV+ (8), monomorphic/monoclonal (14), and of B-cell lineage (13; Diffuse Large B Cell Lymphoma in 11). Non-Hodgkin’s Lymphoma was diagnosed in 7 RTR. 3 RTR had T-cell PTLD.

IS agents (MMF, Tacrolimus) were discontinued in all RTR at diagnosis; maintained on steroid monotherapy. Treatment was chemotherapy either alone or in combination with radiation (2), resection (2), and salvage therapy (1). Post treatment, all RTR remained on steroid monotherapy or with Everolimus (3), Tacrolimus (1), or Azathioprine+Rituximab (1) added. Treatment was complicated by Tumor Lysis Syndrome and infections. 50% of RTR developed renal insufficiency and 31% received dialysis. The mortality rate was 44%, <4 years after diagnosis.

Discussion

PTLD that was EBV-, had T-cell involvement, and localized to the CNS/bone marrow presented with aggressive disease and a higher mortality. Thymoglobulin induction, deceased donor, and donor EBV+ status are potential contributing risk factors for PTLD development; further analysis is still being conducted. Physicians should be aware of the various PTLD manifestations and assertive in management of renal transplant recipients.