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Kidney Week

Abstract: TH-PO837

Incidence and Outcomes of Post-Transplant Lymphoproliferative Disorder After Kidney Transplantation: A 20-Year Multi-Center Experience

Session Information

Category: Transplantation

  • 2102 Transplantation: Clinical

Authors

  • Sardar, Sundus, Penn State Health Milton S Hershey Medical Center, Hershey, Pennsylvania, United States
  • Akkari, Abdel-Rauof M., Penn State Health Milton S Hershey Medical Center, Hershey, Pennsylvania, United States
  • Gul Yousaf Khan, Mohammad, Penn State Health Milton S Hershey Medical Center, Hershey, Pennsylvania, United States
  • Ghahramani, Nasrollah, Penn State Health Milton S Hershey Medical Center, Hershey, Pennsylvania, United States
Background

Post-transplant lymphoproliferative disorder (PTLD) is a rare complication following solid-organ transplantation, involving a spectrum of lymphocytic and/or plasmacytic proliferations in immunosuppressed patients. While often associated with Epstein-Bar Virus (EBV) reactivation, the pathogenesis and risk factors of PTLD are not clearly understood; its clinical manifestations are diverse, and management is challenging with focus on immunosuppression reduction, chemoradiotherapy or surgical resection of localized lesions, while aiming to preserve graft function.

Methods

We performed a retrospective multi-center cohort study using TriNetX, a global federated health research network providing access to electronic medical records across large healthcare organizations (HCOs). We identified 163,826 post-kidney transplant patients from January 15 2003-2023 from 89 HCOs in 13 countries. Patients with confirmed diagnosis of PTLD (n=2181) and those without PTLD (n=161,645) post-renal transplantation were assessed for clinical outcomes including death and kidney transplant failure (KTF) with risk analysis and Kaplan-Meier survival analysis.

Results

Among 163,826 post-renal transplant recipients, 2,181 (1.3%) were identified with confirmed diagnosis of PTLD and 161,645 (98.6%) did not develop PTLD. At the time of transplant, the PTLD group was younger(p<0.0006), more likely to have received a previous transplant(p<0.0001), and on an immunosuppressive agent(p<0.0001). Of those who developed PTLD, 534 (24.4%) died as compared to 23,824 (14.7%) in non-PTLD group; survival rate was 55.87% in PTLD vs. 44.79% in non-PTLD cohort [HR=0.434, 95% CI 0.398-0.473, p = 0.00). Risk difference for death in patients without PTLD vs. with PTLD was -0.097 [RR=0.602, 95% CI -0.116, -0.079; p=0.00]. KTF was confirmed in 34,643 (21.4%) in non-PTLD vs 600 (27.5%) in PTLD group. KTF risk in patients without PTLD and with PTLD was 0.214 and 0.275, respectively, with graft survival of 54.06% and 55.55% in non-PTLD vs. PTLD cohorts, respectively [HR=0.652, 95% CI 0.602-0.707, p=0.008].

Conclusion

Younger age, previous transplant and being on an immunosuppressive agent at time of kidney transplant is associated with occurrence of PTLD. Additionally, PTLD is associated with increased risk of graft failure and death.