Lymphoma after living donor kidney transplantation: an Iranian multicenter experience.
BACKGROUND
Post-transplant lymphoproliferative disorders (PTLD) are well-recognized complications in solid organ recipients. Limited data exist about the development of PTLDs in living kidney recipients. This study deals with a multicenter nationwide experience with kidney recipients from living donors.


METHODS
We reviewed data of PTLD patients from a total population of 6,500 patients transplanted at three different transplant centers in Iran from 1984 to 2006. We also compared their data with 2,250 normal kidney recipients of Baqiyatallah Transplant Center. Data were analyzed to determine potential correlates with the occurrence of PTLD and patient outcome.


RESULTS
Overall, 31 patients were diagnosed as having post-transplant lymphomas. The incidence of PTLD in our kidney transplant population comprised 0.47%. Sixteen (53%) PTLD patients were females, whereas 15 (47%) were males. The mean ages at transplantation and diagnosis were 37.1 and 41.9, respectively. Twelve (63%) patients died, and seven are alive. All deaths occurred within the 1st year after PTLD diagnosis. The mean time period from transplantation to diagnosis of PTLD was 64 (0.7-173) months. Localization of PTLD in the brain associated the worst outcome. Compared to non-PTLD patients, PTLD patients were significantly female predominated (51.6% vs. 32.2%; P = 0.03) and had lower age at transplantation (36.9 years vs. 42.9 years, respectively; P = 0.01). Patients under immunosuppressive regimens containing azathioprine were at higher risk for acquiring PTLDs compared to those with a MMF-containing regimen.


CONCLUSIONS
PTLD is a major threat to kidney transplant recipients. Immunosuppressive agents have a significant role in developing the disease. Early detection of the disease and using more safe immunosuppresants may have beneficial effects on patient outcomes and incidence of the disease.
Pourfarziani
Vahid
V
Nephrology and Urology Research Center, Baqiyatallah Hospital, Mullasadra St., 14155-6437, 1435915371, Tehran, Iran. pourfarziani@gmail.com
Taheri
Saeed
S
Lessan-Pezeshki
Mahboob
M
Nourbala
Mohammad Hossein
MH
Simforoosh
Naser
N
Nemati
Eghlim
E
Makhdoomi
Khadijeh
K
Ghafari
Ali
A
Ahmadpour
Pedram
P
Nafar
Mohsen
M
Einollahi
Behzad
B
D000328:Adult; D001379:Azathioprine / Q000276:immunology; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000276:immunology; D015994:Incidence; D007492:Iran / Q000453:epidemiology; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000276:immunology; D008223:Lymphoma / Q000453:epidemiology / Q000209:etiology* / Q000276:immunology; D008297:Male; D015995:Prevalence; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D016019:Survival Analysis
D007166:Immunosuppressive Agents; D001379:Azathioprine