title: Influence of host-recipient origin on clinical aspects of posttransplantation lymphoproliferative disorders in kidney transplantation.
abstract: BACKGROUND
  Posttransplantation lymphoproliferative disorder (PTLD) is a well-known complication of immunosuppression associated with solid organ transplantation. The donor or host origin of PTLD may influence the outcome of the disease as it has been reported that a donor origin may be associated with a better prognosis. The aim of the study was to determine the origin (recipient or donor) of 12 PTLD occurring in kidney transplant recipients and to correlate the results with clinical findings.
  
  
  METHODS
  Origin of PTLD was determined using HLA DRB1 molecular typing, analysis of multiple short-tandem repeat microsatellite loci, and HLA class I antigen expression by immunohistochemistry.
  
  
  RESULTS
  Combining the three techniques, we found that eight cases originated from the recipient and four cases originated from the donor. The results of the three techniques were concordant and altogether assigned the origin of the tumors. All the donor-origin PTLD were strictly localized to the kidney graft, developed after a mean time of 5 months after transplantation, and regressed after reduction of immunosuppression. In contrast, seven of the eight recipient-origin PTLD presented as multisystemic disease, occurred a mean time of 75.7 months after the transplantation, and had a worse outcome (mortality, five deaths of eight patients, 62.5%).
  
  
  CONCLUSIONS
  These results suggest that PTLD originating from the donor arise in the first year after transplantation into the graft, and that recipient-origin PTLD develop later as an invasive disease. Because it permits simultaneously the analysis of cell morphology and tumor origin, immunohistochemistry is a more reliable technique in the case of graft tumors associated with allograft rejection. The determination of the origin of the tumors seems to be of value in the management of PTLD to predict the outcome and to adapt therapy.
authors.affiliation: Department of Pathology, Dupuytren Hospital, Limoges, France.
authors.forename: Barbara
authors.initials: B
authors.lastname: Petit
authors.forename: Yann
authors.initials: Y
authors.lastname: Le Meur
authors.forename: Arnaud
authors.initials: A
authors.lastname: Jaccard
authors.forename: François
authors.initials: F
authors.lastname: Paraf
authors.forename: Claude Leroux
authors.initials: CL
authors.lastname: Robert
authors.forename: Dominique
authors.initials: D
authors.lastname: Bordessoule
authors.forename: François
authors.initials: F
authors.lastname: Labrousse
authors.forename: Mireille
authors.initials: M
authors.lastname: Drouet
mesh_terms: D000328:Adult; D000368:Aged; D004247:DNA / Q000032:analysis; D005260:Female; D005805:Genes, MHC Class I; D006684:HLA-DR Antigens / Q000235:genetics; D059811:HLA-DRB1 Chains; D006650:Histocompatibility Testing; D006801:Humans; D007150:Immunohistochemistry; D007518:Isoantibodies / Q000032:analysis; D016030:Kidney Transplantation / Q000009:adverse effects*; D008232:Lymphoproliferative Disorders / Q000209:etiology*; D008297:Male; D008875:Middle Aged
chemical_list: D006684:HLA-DR Antigens; D059811:HLA-DRB1 Chains; D007518:Isoantibodies; D004247:DNA