Epidemiology of Posttransplant Lymphoproliferative Disorders in Adult Kidney and Kidney Pancreas Recipients: Report of the French Registry and Analysis of Subgroups of Lymphomas

A registry of posttransplant lymphoproliferative disorders (PTLD) was set up for the entire population of adult kidney transplant recipients in France. Cases of PTLD were prospectively enrolled between January 1, 1998, and December 31, 2007. Ten-year cumulative incidence was analyzed in patients transplanted after January 1, 1989. PTLD risk factors were analyzed in patients transplanted after January 1, 1998 by Cox analysis. Cumulative incidence was 1% after 5 years, 2.1% after 10 years. Multivariate analysis showed that PTLD was significantly associated with: older age of the recipient 4760 years and >60 years (vs. 3346 years, adjusted hazard ratio (AHR) = 1.87, CI = 1.222.86 and AHR = 2.80, CI = 1.734.55, respectively, p < 0.0001), simultaneous kidneypancreas transplantation (AHR = 2.52, CI = 1.275.01 p = 0.008), year of transplant 19981999 and 20002001 (vs. 20062007, AHR = 3.36, CI = 1.646.87 and AHR = 3.08, CI = 1.556.15, respectively, p = 0.003), EBV mismatch (HR = 5.31, CI = 3.368.39, p < 0.001), 5 or 6 HLA mismatches (vs. 04, AHR = 1.54, CI = 1.122.12, p = 0.008), and induction therapy (AHR = 1.42, CI = 12.02, p = 0.05). Analyses of subgroups of PTLD provided new information about PTLD risk factors for early, late, EBV positive and negative, polymorphic, monomorphic, graft and cerebral lymphomas. This nationwide study highlights the increased risk of PTLD as long as 10 years after transplantation and the role of cofactors in modifying PTLD risk, particularly in specific PTLD subgroups.