بررسي موارد بيماريهاي لنفوپروليفراتيو بعد از پيوند كليه : گزارشي از 20 سال تجربه

Post transplantation Lymphoproliferative Disorders in Renal Transplant Recipients:A 20-year Experience

Objective: Lymphoproliferative disorders are among the most serious and potentially fatal complications of chronic immunosuppressants in organ transplant recipients. Post-transplantation lymphoproliferative disorders (PTLD) however, is not an uncommon complication after renal transplantation; we conducted a study to evaluate characteristics of patients with PTLD Materials and Methods: In this cross- sectional study from June 1994 to March 2004 at the Labbafi Nejad Hospital, 2117 renal transplant recipients were enrolled. Patients with neoplasm were evaluated with regard to type of neoplasm, demographic data and survival time. Results: Overall 46 renal transplant recipients had different types of neoplasm. Among these most common types were skin neoplasm (24 cases, 52.2%; Kaposiʹs sarcoma 15 cases, 32.6%) and PTLD (14 cases, 30.4%). Mean (SD) age of PTLD patients at the time of transplantation was 37.86±9.67 years and 42.8 percent were females. Median and mean (SD) time from RT to PTLD diagnosis was 38.5 and 50.35± 41.7 months, respectively (from 1 to 146 months). Types of PTLD in these patients were: kidney (14.3%); GI (14.3%), brain, tonsil, palatine, Hodgkinʹs, lymphoma and ALL (each 7.1%) and 28.6% were defined as unspecific type. The one, five and ten year survival after transplantation was 71.4, 51.4, 44.3 percent, respectively. Despite discontinuing the immunosuppressive therapy of PTLD patients (6 of 14), in 5 survival patients, the graft was active up to mean time of 105.4+57.6 months after transplantation. Conclusion: Our findings show that the prevalence of PTLD after RT is less than other reports in western countries. The course of lymphoproliferative diseases in Kaposiʹs sarcoma after transplantation is more aggressive.