title: Epidemiology of posttransplantation lymphoproliferative disorder in adult renal transplant recipients.
abstract: BACKGROUND
  There is little information in the literature describing the relationship between posttransplantation lymphoproliferative disorder (PTLD) incidence and presentation with both recipient Epstein-Barr virus (EBV) serostatus and EBV status of PTLD histology, particularly in the late posttransplantation period.
  
  
  METHODS
  This study reports the largest UK single-center, single-organ analysis of PTLD to date in a retrospective cohort study of 80 cases occurring in 4189 adult renal transplant recipients.
  
  
  RESULTS
  The incidence rate was 2.6 cases per 1000 patient-years (95% confidence interval [95% CI], 2.1-3.2) for PTLD, 1.8 (95% CI, 1.4-2.4) for non-Hodgkin's lymphoma, and 0.2 (95% CI, 0.07-4.2) for Hodgkin's lymphoma. Non-Hodgkin's lymphoma occurred at a rate 7.6 times that of the adult general population in England, whereas the rate for Hodgkin's lymphoma was 5.9 times. The incidence of PTLD was highest during the 10th to 14th posttransplantation years. Early-onset disease was associated with EBV-seronegative recipient status, EBV-positive histology, and the involvement of extranodal sites. PTLD occurring in EBV-seronegative recipients was associated with EBV nuclear antigen antibody deficiency, polymorphic disease, and the involvement of extranodal sites. EBV-negative histology occurred in 32% of cases at a median time to presentation of 109 months. PTLD involving the allograft, central nervous system, and skin was uncommon and occurred late.
  
  
  CONCLUSIONS
  The incidence of PTLD is highest in the late posttransplantation period. Close clinical surveillance and education for transplant recipients is required for the duration of time while immunosuppressed. Failure to detect EBV DNA in blood should not reassure, particularly in patients with symptoms such as abdominal pain, oropharyngeal complaints, neck lumps, and B-symptoms.
authors.affiliation: Department of Renal Medicine, Central Manchester University Hospitals Foundation Trust, Manchester, UK. muir.morton@cmft.nhs.uk
authors.forename: Muir
authors.initials: M
authors.lastname: Morton
authors.forename: Beatrice
authors.initials: B
authors.lastname: Coupes
authors.forename: Stephen A
authors.initials: SA
authors.lastname: Roberts
authors.forename: Paul E
authors.initials: PE
authors.lastname: Klapper
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Byers
authors.forename: Pamela J
authors.initials: PJ
authors.lastname: Vallely
authors.forename: Kate
authors.initials: K
authors.lastname: Ryan
authors.forename: Michael L
authors.initials: ML
authors.lastname: Picton
mesh_terms: D000328:Adult; D000368:Aged; D000914:Antibodies, Viral / Q000097:blood; D015331:Cohort Studies; D015897:Comorbidity; D004279:DNA, Viral / Q000097:blood; D020031:Epstein-Barr Virus Infections / Q000097:blood / Q000453:epidemiology*; D005260:Female; D004854:Herpesvirus 4, Human / Q000235:genetics / Q000276:immunology; D006689:Hodgkin Disease / Q000097:blood / Q000453:epidemiology* / Q000401:mortality; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000401:mortality; D008228:Lymphoma, Non-Hodgkin / Q000097:blood / Q000453:epidemiology* / Q000401:mortality; D008232:Lymphoproliferative Disorders / Q000097:blood / Q000453:epidemiology* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D012189:Retrospective Studies; D015996:Survival Rate; D014180:Transplantation; D006113:United Kingdom / Q000453:epidemiology
chemical_list: D000914:Antibodies, Viral; D004279:DNA, Viral