Association of Immunosuppressive Maintenance Regimens With Posttransplant Lymphoproliferative Disorder in Kidney Transplant Recipients

被引:63
作者
Sampaio, Marcelo Santos [1 ]
Cho, Yong W. [1 ]
Shah, Tariq [1 ,2 ]
Bunnapradist, Suphamai [3 ]
Hutchinson, Ian V. [1 ,4 ]
机构
[1] Mendez Natl Inst Transplantat, Los Angeles, CA USA
[2] St Vincents Med Ctr, Kidney Transplant Program, Los Angeles, CA USA
[3] Univ Calif Los Angeles, David Geffen Sch Med, Kidney Transplant Program, Los Angeles, CA 90095 USA
[4] Univ So Calif, Sch Pharm, Los Angeles, CA USA
关键词
Kidney transplant; Posttransplant lymphoproliferative disorder; Epstein-Barr virus; UNOS; Immunosuppressive drugs; EPSTEIN-BARR-VIRUS; RENAL-TRANSPLANTATION; UNITED-STATES; RAPAMYCIN IMMUNOSUPPRESSION; MYCOPHENOLATE-MOFETIL; RISK-FACTORS; SIROLIMUS; MALIGNANCY; GROWTH; TACROLIMUS;
D O I
10.1097/TP.0b013e31823ae7db
中图分类号
R392 [医学免疫学]; Q939.91 [免疫学];
学科分类号
100102 ;
摘要
Background. The association of immunosuppressive regimens (ISRs) with posttransplant lymphoproliferative disorder (PTLD) may be related with the Epstein-Barr virus (EBV) recipient serostatus. Methods. We selected primary kidney transplant recipients from Organ Procurement Transplant Network/United Network for Organ Sharing database (2000-2009) who were discharged with a functioning graft and were receiving an ISR including an antiproliferative drug and a calcineurin inhibitor as follows: mycophenolate mofetil (MMF)/mycophenolate sodium+tacrolimus (TAC), MMF+cyclosporine A (CsA); mammalian target of rapamycin inhibitor (mTORi)+TAC; and mTORi+CsA. Adjusted risks of PTLD, rejection, death, and graft failure were examined in all recipients and compared between EBV+ nd EBV-recipients. Results. Of 114,025 recipients, 754 developed PTLD (5-year incidence of 0.84%). Adjusted hazard ratio for PTLD was 4.39 (95% CI: 3.60 -5.37) for EBV-versus EBV+recipients; and 1.40 (95% CI: 1.03-1.90) for mTORi+TAC, 0.80 (95% CI: 0.65-0.99) for MMF+CsA, and 0.90 (95% CI: 0.57-1.42) for mTORi+CsA, versus MMF+TAC users. In EBV-recipients, hazard ratio for PTLD was 1.98 (95% CI: 1.28 - 3.07) for mTORi+TAC, 0.45 (95% CI: 0.28-0.72) for MMF+CsA, and 0.84 (95% CI: 0.39-1.80) for mTORi+CsA users versus MMF+TAC. No difference was seen in EBV+recipient groups. Rejection rates were higher among MMF+CsA recipients in both EBV groups. Death and graft failure risk were increased in all EBV+ISR groups, while in EBV-these risks were only increased in mTORi+TAC group versus MMF+TAC. Conclusions. In EBV-recipients, immunosuppression with mTORi+TAC was associated with increased risk of PTLD, death, and graft failure, while MMF+CsA use was associated with a trend to increased risk of rejection, lower PTLD risk, and similar risk for graft failure when compared with MMF+TAC.
引用
收藏
页码:73 / 81
页数:9
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