title: Post-transplantation lymphoproliferative disorder after kidney transplantation: report of a nationwide French registry and the development of a new prognostic score.
abstract: OBJECTIVE
  Post-transplantation lymphoproliferative disorder (PTLD) is associated with significant mortality in kidney transplant recipients. We conducted a prospective survey of the occurrence of PTLD in a French nationwide population of adult kidney recipients over 10 years.
  
  
  METHODS
  A French registry was established to cover a nationwide population of transplant recipients and prospectively enroll all adult kidney recipients who developed PTLD between January 1, 1998, and December 31, 2007. Five hundred patient cases of PTLD were referred to the French registry. The prognostic factors for PTLD were investigated using Kaplan-Meier and Cox analyses.
  
  
  RESULTS
  Patients with PTLD had a 5-year survival rate of 53% and 10-year survival rate of 45%. Multivariable analyses revealed that age > 55 years, serum creatinine level > 133 μmol/L, elevated lactate dehydrogenase levels, disseminated lymphoma, brain localization, invasion of serous membranes, monomorphic PTLD, and T-cell PTLD were independent prognostic indicators of poor survival. Considering five variables at diagnosis (age, serum creatinine, lactate dehydrogenase, PTLD localization, and histology), we constructed a prognostic score that classified patients with PTLD as being at low, moderate, high, or very high risk for death. The 10-year survival rate was 85% for low-, 80% for moderate-, 56% for high-, and 0% for very high-risk recipients.
  
  
  CONCLUSIONS
  This nationwide study highlights the prognostic factors for PTLD and enables the development of a new prognostic score. After validation in an independent cohort, the use of this score should allow treatment strategies to be better tailored to individual patients in the future.
authors: Nephrology-Transplantation Department, Strasbourg University Hospital, Strasbourg, France. sophie.caillard@chru-strasbourg.fr
authors: Sophie
authors: S
authors: Caillard
authors: Raphael
authors: R
authors: Porcher
authors: François
authors: F
authors: Provot
authors: Jacques
authors: J
authors: Dantal
authors: Sylvain
authors: S
authors: Choquet
authors: Antoine
authors: A
authors: Durrbach
authors: Emmanuel
authors: E
authors: Morelon
authors: Valérie
authors: V
authors: Moal
authors: Benedicte
authors: B
authors: Janbon
authors: Eric
authors: E
authors: Alamartine
authors: Claire
authors: C
authors: Pouteil Noble
authors: Delphine
authors: D
authors: Morel
authors: Nassim
authors: N
authors: Kamar
authors: Matthias
authors: M
authors: Buchler
authors: Marie France
authors: MF
authors: Mamzer
authors: Marie Noelle
authors: MN
authors: Peraldi
authors: Christian
authors: C
authors: Hiesse
authors: Edith
authors: E
authors: Renoult
authors: Olivier
authors: O
authors: Toupance
authors: Jean Philippe
authors: JP
authors: Rerolle
authors: Sylvie
authors: S
authors: Delmas
authors: Philippe
authors: P
authors: Lang
authors: Yvon
authors: Y
authors: Lebranchu
authors: Anne Elisabeth
authors: AE
authors: Heng
authors: Jean Michel
authors: JM
authors: Rebibou
authors: Christiane
authors: C
authors: Mousson
authors: Denis
authors: D
authors: Glotz
authors: Joseph
authors: J
authors: Rivalan
authors: Antoine
authors: A
authors: Thierry
authors: Isabelle
authors: I
authors: Etienne
authors: Marie Christine
authors: MC
authors: Moal
authors: Laetitia
authors: L
authors: Albano
authors: Jean François
authors: JF
authors: Subra
authors: Nacera
authors: N
authors: Ouali
authors: Pierre François
authors: PF
authors: Westeel
authors: Michel
authors: M
authors: Delahousse
authors: Robert
authors: R
authors: Genin
authors: Bruno
authors: B
authors: Hurault de Ligny
authors: Bruno
authors: B
authors: Moulin
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects*; D008232:Lymphoproliferative Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D011379:Prognosis; D011446:Prospective Studies; D012042:Registries / Q000706:statistics & numerical data; D012307:Risk Factors; D016019:Survival Analysis; D055815:Young Adult