title: Associated characteristics and impact on survival of post renal-transplantation lymphoproliferative disease: case-control study from a regional registry.
abstract: BACKGROUND
  Lymphoproliferative disease (LPD) after renal transplantation (RT) is an unusual complication but one that impacts greatly on survival. We examined possible predisposing factors and their effect on survival using data from the Andalusian Transplant Co-ordination Information System (SICATA) regional computerized database of patients on renal replacement therapy due to chronic kidney disease (CKD).
  
  
  METHODS
  The study population comprised all RT undertaken at adult centers in Andalusia from January 1, 1990 to December 31, 2009 (N = 5577). We retrospectively analyzed cases at December 31, 2011 (N = 60). A control group comprised the 2 closest RT in time done at the same center and with equal or greater graft survival at the time of diagnosis of LPD in the associated case (N = 120). The basic variables were obtained from the general register (1990-2009) and widened from the specific register (2000-2009). Case-control comparison of survival was done with Kaplan-Meier from diagnosis to death or organ loss censored for death. Cox univariate and multivariate (LPD plus available covariables of demonstrated effect) analyses were done.
  
  
  RESULTS
  We found no significant differences between cases and controls regarding the characteristics of the recipient or of the donor/organ, initial immunosuppression by intention to treat, or post-RT course. The impact on recipient survival 5 years after diagnosis was as follows: LPD, 35%; controls, 90% (P < .000). Cox univariate analysis showed the relative risk (RR) of death for LPD was 11.36 (95% confidence interval [CI], 6.2-20.9; P < .000) and the multivariate analysis showed relative risk (RR) = 13.87 (7.45-25.3; P < .000). The impact on death-censored graft survival 5 years after diagnosis was as follows: LPD, 65%; controls, 87% (P = .007). Cox univariate analysis was as follows: RR of failure for LPD, 2.70 (95% CI, 1.3-5.7; P = .009).
  
  
  CONCLUSIONS
  We found no significant differences between LPD cases and contemporary controls regarding the basic characteristics of the recipient, donor/organ, initial immunosuppression, or initial graft evolution. There was an enormous impact on both patient and graft survival.
authors: SICATA (Andalusian Transplant Co-ordination Information System), Seville, Spain.
authors: M A
authors: MA
authors: Gentil Govantes
authors: M
authors: M
authors: Vidal Blandino
authors: P
authors: P
authors: Ruiz Esteban
authors: C
authors: C
authors: Rodelo Haad
authors: J
authors: J
authors: Torrado Masero
authors: M
authors: M
authors: Toro Ramos
authors: D
authors: D
authors: Burgos Rodríguez
authors: M
authors: M
authors: Alonso Gil
authors: A
authors: A
authors: Osuna Ortega
authors: A
authors: A
authors: Franco Esteve
mesh_terms: D000328:Adult; D005260:Female; D006085:Graft Survival; D006801:Humans; D053208:Kaplan-Meier Estimate; D016030:Kidney Transplantation / Q000009:adverse effects / Q000401:mortality*; D008232:Lymphoproliferative Disorders / Q000175:diagnosis / Q000209:etiology / Q000401:mortality*; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D016016:Proportional Hazards Models; D012042:Registries; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome