title: Post-transplant lymphoproliferative disorder in adult renal transplant recipients: survival and prognosis.
abstract: Post-transplant lymphoproliferative disorder (PTLD) is a rare, serious complication following solid organ transplantation, with an incidence of 2.6 cases per 1000 patient years. Optimal treatment strategies and risk stratifications specific to kidney transplantation are lacking and PTLD mortality remains high. This study investigated survival and prognosis in 89 cases of PTLD presenting over 44 years at Manchester Royal Infirmary. Patient survival following diagnosis was 72% at 6 months, 67% at 1 year and 54% at 3 years. In multivariate analysis, a poorer 3 year survival was associated with acute kidney injury at diagnosis (p = 0.0001), impaired renal function (p = 0.04), early onset (p = 0.02), T cell disease (p = 0.02) and previous treatment with anti-thymocyte globulin (p = 0.04). The inclusion of graft function adds prognostic value to risk stratification and should be explored further. Strategies to improve survival should include timing and choice of immuno-chemotherapy, preparation for dialysis and aggressive surveillance for sepsis and treatment toxicity.
authors.affiliation: a Department of Renal Medicine , Central Manchester University Hospitals Foundation Trust , Manchester , UK.
authors.forename: Muir
authors.initials: M
authors.lastname: Morton
authors.affiliation: a Department of Renal Medicine , Central Manchester University Hospitals Foundation Trust , Manchester , UK.
authors.forename: Beatrice
authors.initials: B
authors.lastname: Coupes
authors.affiliation: b Center for Epidemiology, Institute of Population Health, Salford Royal NHS Foundation Trust , Salford , UK.
authors.forename: James
authors.initials: J
authors.lastname: Ritchie
authors.affiliation: c Centre for Biostatistics, Institute of Population Health, University of Manchester , Manchester , UK.
authors.forename: Stephen A
authors.initials: SA
authors.lastname: Roberts
authors.affiliation: d Department of Clinical Virology , Central Manchester University Hospitals Foundation Trust , Manchester , UK.|e Microbiology and Virology Unit, School of Translational Medicine, the University of Manchester, Manchester Academic Health Sciences Centre , Manchester , UK.
authors.forename: Paul E
authors.initials: PE
authors.lastname: Klapper
authors.affiliation: f Department of Histopathology , Central Manchester University Hospitals Foundation Trust , Manchester , UK.|g School of Cancer and Enabling Sciences, Faculty of Medical and Human Sciences, University of Manchester , Manchester , UK.|h Manchester Academic Health Science Centre , Manchester , UK.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Byers
authors.affiliation: e Microbiology and Virology Unit, School of Translational Medicine, the University of Manchester, Manchester Academic Health Sciences Centre , Manchester , UK.
authors.forename: Pamela J
authors.initials: PJ
authors.lastname: Vallely
authors.affiliation: h Manchester Academic Health Science Centre , Manchester , UK.|i Department of Haematology , Central Manchester University Hospitals Foundation Trust , Manchester , UK.
authors.forename: Kate
authors.initials: K
authors.lastname: Ryan
authors.affiliation: a Department of Renal Medicine , Central Manchester University Hospitals Foundation Trust , Manchester , UK.
authors.forename: Michael L
authors.initials: ML
authors.lastname: Picton
keywords: PTLD; Survival; chemotherapy; immunosuppression; rituximab