Analysis of Factors that Influence Survival with Post-Transplant

Analysis of Factors that Influence Survival with Post-Transplant
Significant mortality is associated with post-transplant lymphoproliferative disorder (PTLD) in kidney transplant recipients (KTX). Univariate/multivariate risk factor survival analysis of US PTLD KTX reported to Israel Penn International Transplant Tumor Registry from November 1968 to January 2000 was performed. PTLD presented 18 (median) (range 1–310) months in 402 KTX. Death rates were greater for those diagnosed within 6 months (64%) versus beyond 6 months (54%, p = 0.04). No differences in death risk for gender, race, immunosuppression, EBV, B or T cell positivity were identified. Death risk increased for multiple versus single sites (73% vs. 53%, hazards ratio (HR) 1.4). A 1-year increase in age increased HR for death by 2%. Surgery was associated with increased survival (55% vs. 0% without surgery) (p < 0.0001). Patients with allograft involvement, treated with transplant nephrectomy alone (n = 20), had 80% survival versus 53% without allograft removal (n = 15) (p < 0.001). Overall survival was 69% for allograft involvement alone versus 36% for other organ involvement plus allograft (n = 19 alive) (p < 0.0001). Death risk was greater for multiple site PTLD and increasing age, and risks were additive. Univariate analysis identified increased death risk for those not receiving surgery, particularly allograft involvement alone.

Post-transplant lymphoproliferative disorder (PTLD) was recognized over three decades ago and has been noted throughout all immunosuppressive eras . PTLD affects less than 1% of kidney transplant recipients (KTX) but results in death in up to 44% of patients. Recently, an increase in the incidence of PTLD has been reported and has suggested that calcineurin inhibitors may be responsible for the increase . Previous literature reviews have indicated that various factors, including number of site involved and Epstein–Barr virus (EBV) status may predict survival in patients with PTLD .

The Israel Penn International Transplant Tumor Registry (IPITTR) is a voluntary registry (reporting is not mandatory), which has collected data on malignancies in transplant patients from 1968 to 2004. Multivariate risk factor analyses for PTLD outcomes and survival have been limited to relatively small experiences and previous IPITTR PTLD reports have involved only descriptive statistical analyses. Herein we present the first multivariate risk factor analysis for variables that influence survival in KTX with PTLD.