title: Lymphoproliferative disorders after adult kidney transplant: epidemiology and comparison of registry report with claims-based diagnoses.
abstract: BACKGROUND
  Posttransplant lymphoproliferative disorder (PTLD) is a major complication of kidney transplant.
  
  
  METHODS
  Retrospective cohort study comparing PTLD incidence rates using US Medicare claims and Organ Procurement and Transplantation Network (OPTN) data, examining risk factors for PTLD in OPTN data, and studying recipient and graft survival after PTLD diagnosis.
  
  
  METHODS
  All adult first-transplant patients who underwent deceased or living donor kidney-only transplants in 2000-2006 (n = 89,485) followed up through 3 years posttransplant.
  
  
  METHODS
  Recipient and donor characteristics, HLA mismatches, viral serologic test results, and initial immunosuppression.
  
  
  RESULTS
  OPTN-reported or Medicare claims-based PTLD diagnosis, recipient and graft survival after OPTN-reported PTLD diagnosis.
  
  
  METHODS
  Adjusted HRs for PTLD diagnosis estimated using a Cox proportional hazards model; probability of survival free of all-cause graft failure estimated using the Kaplan-Meier method.
  
  
  RESULTS
  The incidence rate of PTLD during the first posttransplant year was 2-fold higher in Medicare claims (0.46/100 patient-years; 95% CI, 0.39-0.53) than in OPTN data (0.22/100 patient-years; 95% CI, 0.17-0.27). Factors associated with increased rates of PTLD included older age, white race (vs African American), induction with T-cell-depleting antibodies, Epstein-Barr virus seronegativity at the time of transplant, and cytomegalovirus seronegativity at the time of transplant. The adjusted risk of death with graft function was 17.5 (95% CI, 14.3-21.4) times higher after a report of PTLD, and the risk of death-censored graft failure was 5.5 (95% CI, 3.9-7.7) times higher.
  
  
  CONCLUSIONS
  Shortcomings inherent in large databases, including inconsistencies in patient follow-up, reporting, and coding practices by transplant centers; insufficient registry data to analyze acute rejection episodes and antirejection treatment; no available data for potential effects of different types of PTLD treatment on patient outcomes.
  
  
  CONCLUSIONS
  Despite the limitations of data collected by registries, PTLD clearly is an important complication; both mortality and death-censored graft failure increase after PTLD.
authors.affiliation: Chronic Disease Research Group, Minneapolis Medical Research Foundation, Minneapolis, MN, USA. kasis001@umn.edu
authors.forename: Bertram L
authors.initials: BL
authors.lastname: Kasiske
authors.forename: Aleksandra
authors.initials: A
authors.lastname: Kukla
authors.forename: Dolca
authors.initials: D
authors.lastname: Thomas
authors.forename: Jennifer
authors.initials: J
authors.lastname: Wood Ives
authors.forename: Jon J
authors.initials: JJ
authors.lastname: Snyder
authors.forename: Yang
authors.initials: Y
authors.lastname: Qiu
authors.forename: Yi
authors.initials: Y
authors.lastname: Peng
authors.forename: Vikas R
authors.initials: VR
authors.lastname: Dharnidharka
authors.forename: Ajay K
authors.initials: AK
authors.lastname: Israni
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006085:Graft Survival; D006801:Humans; D015994:Incidence; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000401:mortality; D008232:Lymphoproliferative Disorders / Q000453:epidemiology*; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data*; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D016016:Proportional Hazards Models; D012042:Registries / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D055815:Young Adult