Post-transplantation lymphoproliferative disorder after kidney transplantation: report of a nationwide French registry and the development of a new prognostic score.
Sophie Caillard
(1)
,
Raphael Porcher
(2)
,
François Provot
(3, 4)
,
Jacques Dantal
(5)
,
Sylvain Choquet
(6)
,
Antoine Durrbach
(7)
,
Emmanuel Morelon
(8)
,
Valérie Moal
(9)
,
Benedicte Janbon
(1)
,
Eric Alamartine
(10)
,
Claire Pouteil Noble
(6)
,
Delphine Morel
(6)
,
Nassim Kamar
(11)
,
Matthias Buchler
(6)
,
Marie France Mamzer
(6)
,
Marie Noelle Peraldi
(6)
,
Christian Hiesse
(6)
,
Edith Renoult
(6)
,
Olivier Toupance
(12)
,
Jean-Philippe Rerolle
(13)
,
Sylvie Delmas
(1)
,
Philippe Lang
(14)
,
Yvon Lebranchu
(15)
,
Anne Elisabeth Heng
(1)
,
Jean Michel Rebibou
(16)
,
Christiane Mousson
(6)
,
Denis Glotz
(17)
,
Joseph Rivalan
(1)
,
Antoine Thierry
(18, 19)
,
Isabelle Etienne
(1)
,
Marie Christine Moal
(1)
,
Laetitia Albano
(20)
,
Jean François Subra
(1)
,
Nacera Ouali
(1)
,
Pierre François Westeel
(1)
,
Michel Delahousse
(13)
,
Robert Genin
(1)
,
Bruno Hurault de Ligny
(1)
,
Bruno Moulin
(21)
1
Service de néphrologie [Rennes]
2 Service de Biostatistiques
3 CHU Saint-Antoine [AP-HP]
4 Service de néphrologie
5 U1064 Inserm - CRTI - Centre de Recherche en Transplantation et Immunologie
6 Service de néphrologie (CHU de Dijon)
7 Service de néphrologie
8 Department of Transplantation Medicine
9 ADES - Anthropologie bio-culturelle, Droit, Ethique et Santé
10 CCCF - Centre commun de Cytométrie en Flux
11 Service de Néphrologie - Hypertension Artérielle Dialyse - Transplantation
12 URCA - Université de Reims Champagne-Ardenne
13 Service de transplantation rénale
14 IMRB - Institut Mondor de Recherche Biomédicale
15 Unité Transversale d'Allergologie, Néphrologie et Immunologie Clinique
16 RIGHT - Interactions hôte-greffon-tumeur, ingénierie cellulaire et génique - UFC (UMR INSERM 1098)
17 Service de Néphrologie [Saint-Louis]
18 IRTOMIT - Ischémie Reperfusion en Transplantation d’Organes Mécanismes et Innovations Thérapeutiques
19 Service de néphrologie - hémodialyse et transplantation rénale
20 Service de néphrologie
21 Service de Néphrologie et Transplantation
2 Service de Biostatistiques
3 CHU Saint-Antoine [AP-HP]
4 Service de néphrologie
5 U1064 Inserm - CRTI - Centre de Recherche en Transplantation et Immunologie
6 Service de néphrologie (CHU de Dijon)
7 Service de néphrologie
8 Department of Transplantation Medicine
9 ADES - Anthropologie bio-culturelle, Droit, Ethique et Santé
10 CCCF - Centre commun de Cytométrie en Flux
11 Service de Néphrologie - Hypertension Artérielle Dialyse - Transplantation
12 URCA - Université de Reims Champagne-Ardenne
13 Service de transplantation rénale
14 IMRB - Institut Mondor de Recherche Biomédicale
15 Unité Transversale d'Allergologie, Néphrologie et Immunologie Clinique
16 RIGHT - Interactions hôte-greffon-tumeur, ingénierie cellulaire et génique - UFC (UMR INSERM 1098)
17 Service de Néphrologie [Saint-Louis]
18 IRTOMIT - Ischémie Reperfusion en Transplantation d’Organes Mécanismes et Innovations Thérapeutiques
19 Service de néphrologie - hémodialyse et transplantation rénale
20 Service de néphrologie
21 Service de Néphrologie et Transplantation
Raphael Porcher
- Function : Author
- PersonId : 756384
- ORCID : 0000-0002-5277-4679
- IdRef : 071086757
Antoine Durrbach
- Function : Author
- PersonId : 768839
- ORCID : 0000-0003-0385-8726
- IdRef : 061677949
Nassim Kamar
- Function : Author
- PersonId : 862464
- ORCID : 0000-0003-1930-8964
- IdRef : 067702414
Christiane Mousson
- Function : Author
- PersonId : 762476
- ORCID : 0000-0003-0861-2506
Abstract
PURPOSE: Post-transplantation lymphoproliferative disorder (PTLD) is associated with significant mortality in kidney transplant recipients. We conducted a prospective survey of the occurrence of PTLD in a French nationwide population of adult kidney recipients over 10 years. PATIENTS AND METHODS: A French registry was established to cover a nationwide population of transplant recipients and prospectively enroll all adult kidney recipients who developed PTLD between January 1, 1998, and December 31, 2007. Five hundred patient cases of PTLD were referred to the French registry. The prognostic factors for PTLD were investigated using Kaplan-Meier and Cox analyses. RESULTS: Patients with PTLD had a 5-year survival rate of 53% and 10-year survival rate of 45%. Multivariable analyses revealed that age > 55 years, serum creatinine level > 133 μmol/L, elevated lactate dehydrogenase levels, disseminated lymphoma, brain localization, invasion of serous membranes, monomorphic PTLD, and T-cell PTLD were independent prognostic indicators of poor survival. Considering five variables at diagnosis (age, serum creatinine, lactate dehydrogenase, PTLD localization, and histology), we constructed a prognostic score that classified patients with PTLD as being at low, moderate, high, or very high risk for death. The 10-year survival rate was 85% for low-, 80% for moderate-, 56% for high-, and 0% for very high-risk recipients. CONCLUSION: This nationwide study highlights the prognostic factors for PTLD and enables the development of a new prognostic score. After validation in an independent cohort, the use of this score should allow treatment strategies to be better tailored to individual patients in the future.