title: Racial variation in the development of posttransplant lymphoproliferative disorders after renal transplantation.
abstract: BACKGROUND
  We previously reported that posttransplant lymphoproliferative disorders (PTLD) occurred more frequently in non-African American (AF) kidney transplant recipients. An in-depth analysis of racial differences in the development of PTLD has not been reported.
  
  
  METHODS
  We assessed Medicare claims for PTLD in a retrospective cohort of 53,719 patients who underwent transplantation from January 2000 to September 2006 and followed up through December 2007.
  
  
  RESULTS
  There were 719 (1.3%) patients with claims for PTLD. Non-AF recipient race (including all races analyzed separately, adjusted hazard ratio [AHR] 1.38, 95% confidence interval [CI] 1.13-1.68), recipient Epstein-Barr virus (EBV) immunoglobulin G (IgG) seronegative status (AHR 1.88, 95% CI 1.53-2.34), and de novo sirolimus (AHR 1.22, 95% CI 1.03-1.45) were associated with an increased risk of PTLD. Furthermore, de novo sirolimus showed a significant interaction with EBV IgG; among EBV IgG-negative recipients, sirolimus use was significant (P = 0.003), but among EBV IgG-positive recipients, it was not significant (P = 0.18). EBV IgG-seronegative status was significant in all races except for AFs, and racial differences were a significant effect modifier for EBV IgG status and risk of PTLD. Mortality subsequent to PTLD did not differ by race. CONCLUSIONS.: AF kidney transplant recipients were at lower risk for PTLD, irrespective of the recipient EBV IgG serostatus. On the contrary, recipient EBV IgG-seronegative status was associated with a higher risk of PTLD in the non-AF population. De novo sirolimus therapy was associated with increased risk of PTLD in EBV IgG-negative recipients, regardless of race.
authors.affiliation: Nephrology Service, Walter Reed Army Medical Center, Washington, DC 20307, USA. robert.nee@us.army.mil
authors.forename: Robert
authors.initials: R
authors.lastname: Nee
authors.forename: Frank P
authors.initials: FP
authors.lastname: Hurst
authors.forename: Vikas R
authors.initials: VR
authors.lastname: Dharnidharka
authors.forename: Rahul M
authors.initials: RM
authors.lastname: Jindal
authors.forename: Lawrence Y
authors.initials: LY
authors.lastname: Agodoa
authors.forename: Kevin C
authors.initials: KC
authors.lastname: Abbott
mesh_terms: D000328:Adult; D000368:Aged; D044383:Black People; D005260:Female; D004854:Herpesvirus 4, Human / Q000276:immunology; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016030:Kidney Transplantation / Q000276:immunology; D008232:Lymphoproliferative Disorders / Q000097:blood / Q000453:epidemiology* / Q000276:immunology; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data; D008875:Middle Aged; D015999:Multivariate Analysis; D012189:Retrospective Studies; D020123:Sirolimus / Q000627:therapeutic use; D014481:United States / Q000453:epidemiology; D044465:White People; D001741:Black or African American
chemical_list: D007074:Immunoglobulin G; D007166:Immunosuppressive Agents; D020123:Sirolimus