Clinical Analysis Of Posttransplant Lymphoproliferative Disorder In Kidney Transplant Recipients And Hematopoietic Stem Cell Transplant Recipients

Background and purposePost-transplantation Lymphoproliferative Disorders are a heterogeneous group of complication associated with immunosuppression following solid organ and hematopoietic stem cell transplantation,ranging from benign proliferation of lymphocytes to aggressive,malignant lymphoma.The characteristics of PTLD is not fully understood at present,long-term iatrogenic immunosuppression,Epstein-Barr Virus(EBV)infection,transplanted organ type and gene may contribute to it.The morbidity of PTLD is low and the manifestations are diverse clinically.However,PTLD can occur in various systems of the whole body at any time after transplantation,and clinical diagnosis is difficult due to the lack of specificity.Definitive diagnosis depends on the pathological biopsy.PTLD developed rapidly after onset with poor prognosis,which is a serious complication of long-term survival and quality of life of transplant recipients.The main treatments include immunosuppression reduction,Rituximab,chemotherapy,radiotherapy and surgery,etc.However,there is no uniform standard for PTLD treatment currently.This study aims to provide evidence and clinical experience for post-transplant lymphoproliferative disorder(PTLD)by comparing characteristics of PTLD in kidney and hematopoietic stem cell transplant recipients and reviewing literature.MethodsTwenty-seven adult PTLD patients treated in our center from 2000 to 2017 were retrospectively included,among which 11 were kidney transplant recipients(KT group)and 16 were hematopoietic stem cell transplant(HSCT group)recipients.Clinical characteristics and outcomes were analyzed in two groups.Besides,Kaplan-Meier survival analysis was used to evaluate factors associated with prognosis of PTLD.ResultsFrom 2001 to 2017,Twenty-seven adult PTLD patients were diagnosed PTLD in our center with biopsy,divided the patients into KT(Kidney Transplantation)group and the HSCT(Hematopoietic Stem Cell Transplantation)group.The morbidity of PTLD were 0.5%、1.1%in KT group and HSCT group respectively.PTLD patients in the HSCT group were younger((30.5±10.7 yr VS54.9±11.8 yr,P<0.01),P<0.01)with earlier onset(3.1 mo versus 105.1 mo,P<0.01),and the EBV was more frequently detected(13/16,81.3%).The main clinical manifestation of HSCT was B symptom.Extranodal involvement was the initial symptom in the KT group and the main pathological type was diffuse large B cell lymphoma(DLBCL)and its subtype(lymphomatoid granulomatosis Ⅱ-Ⅲ,LYG),with a 38.4%gastrointestinal tract involvement.Of all the patients,13 were fatal,with recurrence or progression of 3 cases and the median survival time is about 35.0 months.The five years over survival is 46.8±10.5%,with the progression-free survival 40.2%.There are a variety of treatments due to the lack of uniform standard.According to the Kaplan Meier survival analysis,the application of ATG,rejection or graft-versus-host disease,high ECOG PS advanced tumor is the prognostic factors of PTLD.ConclusionThe majority of the KT-PTLD is late-onset with monomorphic feature,and has a relatively common of extranodal involvement,meanwhile,the HSCT-PTLD show early-onset and with multiple pathological features,and has a close association with EBV infectious.The histological type,application of ATG,graft rejection or graft-versus-host disease and high ECOG PS is the prognostic factors of PTLD.