Retransplantation after post-transplant lymphoproliferative disorders: an OPTN/UNOS database analysis.
Post-transplant lymphoproliferative disorders (PTLD) are a life-threatening complication of immunosuppressive therapy. Retransplantation of survivors remains controversial. The Organ Procurement and Transplant Network/United Network for Organ Sharing database was reviewed for individuals who developed PTLD and underwent retransplant from 1987 through 2004. Sixty-nine retransplants have been performed: 27 kidney, 22 liver, 9 lung, 6 heart, 4 intestine and 1 pancreas. At first transplant, most subjects (63.8%) were <17 years of age and was similar at retransplant with 50.7% less than 17 years. Time from transplant to PTLD was <1 year in 33.3%, 1-3 years in 21.7%, 3-5 years in 21.7%, 5-10 years in 21.7% and >10 years in 1.4%. Time from PTLD to retransplant was <1 year in 24.6%, 1-3 years in 37.7%, 3-5 years in 17.4% and 5-10 years in 20.3%. Induction agents were used in 21.7% of first and 47.8% of retransplants. Immunosuppression for first transplant was cyclosporine (CSA) in 55.1%, tacrolimus (TAC) in 27.5% versus CSA in 26.1%, TAC in 66.7% of retransplants. At last follow-up, patient and graft survival are 85.5% and 73.9%, respectively. Most subjects retransplanted after PTLD are <17 years on TAC-based immunosuppression. Patient/graft survival is excellent and retransplantation in PTLD subjects should be considered acceptable.
Johnson
S R
SR
The Transplant Center, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA. srjohnso@bidmc.harvard.edu
Cherikh
W S
WS
Kauffman
H M
HM
Pavlakis
M
M
Hanto
D W
DW
D016208:Databases, Factual; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008232:Lymphoproliferative Disorders / Q000276:immunology*; D008297:Male; D011183:Postoperative Complications / Q000276:immunology*; D012086:Reoperation / Q000706:statistics & numerical data*; D013997:Time Factors; D009927:Tissue and Organ Procurement / Q000458:organization & administration; D014181:Transplantation Immunology; D014850:Waiting Lists
D007166:Immunosuppressive Agents