Post-transplant lymphoproliferative disorders after live donor renal transplantation

被引:13
作者
Jain, M [1 ]
Badwal, S
Pandey, R
Srivastava, A
Sharma, RK
Gupta, RK
机构
[1] Sanjay Gandhi Postgrad Inst Med Sci, Dept Pathol, Lucknow, Uttar Pradesh, India
[2] Sanjay Gandhi Postgrad Inst Med Sci, Dept Urol & Renal Transplantat, Lucknow, Uttar Pradesh, India
[3] Sanjay Gandhi Postgrad Inst Med Sci, Dept Nephrol, Lucknow, Uttar Pradesh, India
关键词
live related; post-transplant lymphoproliferative disorders; renal allograft;
D O I
10.1111/j.1399-0012.2005.00406.x
中图分类号
R61 [外科手术学];
学科分类号
摘要
The development of post-transplant lymphoproliferative disorders (PTLD) is a well-recognized complication of solid organ transplantation in patients receiving immunosuppressive therapy. The literature on PTLD in live renal allograft recipients is scarce and most of the data pertains to PTLD in cadaveric transplants. As live donor grafts form the mainstay of transplantation programme in India, this study was carried out to define the profile of PTLD in live donor renal allograft recipients. On retrospective evaluation, nine cases of PTLD amongst 1700 live donor allograft recipients from January 1989 to August 2004, were detected at a tertiary care hospital in north India. The clinicopathological features of these cases were evaluated. Mean age at diagnosis of PTLD was 38 yr with median post-transplant latency period of 7 yr. All cases were from extra-renal sites, five being in ileum/jejunum, three in retroperitoneal lymph nodes and one in epididymus. All cases received cyclosporin, azathioprine and prednisolone in varying combinations as immunosuppressive therapy. One case was treated for rejection by anti-thymocyte globulin. Seven patients were seronegative for Epstein-Barr virus at the time of diagnosis. All were B-cell monomorphic PTLD, classifiable as B-cell diffuse large cell lymphomas, with five extranodal and three nodal lymphomas. Management included reduction in immunosuppression, acyclovir therapy, surgical excision and chemotherapy. On follow-up, four patients died, two presented with recurrence, two were in remission and one was lost to follow-up. This study comprising of live related/unrelated renal allograft recipients observed late onset high grade monomorphic PTLD with paucity of early onset polymorphic lesions. Long post-transplant latency period, aggressive behaviour and poor response to treatment necessitate long-term cancer surveillance to facilitate early detection and newer therapeutic strategies to improve the outcome in these patients.
引用
收藏
页码:668 / 673
页数:6
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