title: Posttransplant Lymphoproliferative Disorders in Irish Renal Transplant Recipients: Insights From a National Observational Study.
abstract: BACKGROUND
  Posttransplant lymphoproliferative disorders (PTLD) are a common malignancy after renal transplantation with a high incidence of PTLD described in the first posttransplant year. We sought to determine incidence and risk determinants of PTLD in Irish kidney transplant recipients.
  
  
  METHODS
  Retrospective observational study of 1996 adult first kidney transplant recipients between 1991 and 2010 in the Republic of Ireland. Recipients were cross-referenced with the National Cancer Registry to determine incidence of PTLD. Kaplan-Meier analysis was performed for PTLD-free survival, allograft survival, and patient survival after PTLD. Cox proportional hazards models were used to identify independent risk factors for PTLD in our population.
  
  
  RESULTS
  We identified 31 cases of PTLD during the study period. Histological subgroups included: early lesions (n = 1); polymorphic PTLD (n = 1); monomorphic PTLD (n = 27), Hodgkin disease (n = 2). Median time to PTLD diagnosis was 8.3 (range, 1.2-13.9) years. Cumulative incidence (95% CI) of PTLD at 1, 2, 3, 5, 10, and 15 years was 0%, 0.16% (0.05-0.5%), 0.21% (0.08-0.57%), 0.21% (0.08-0.57%), 1.76% (1.15-2.69%), and 3.07% (2.1-4.43%), respectively. Allograft survival after PTLD diagnosis was 94.4% (66.6-99.2%) at 5 years. Patient survival after PTLD diagnosis was 64% at 1 year, 53% at 2 years, 48% at 5 years, and 37% at 10 years. No risk factors for PTLD were identified.
  
  
  CONCLUSIONS
  We found a paucity of early onset PTLD in our cohort with no cases in the first posttransplant year. Potential contributing factors included a high prevalence of previous Epstein-Barr virus exposure and a relatively low immunological risk profile in our recipient cohort compared with prior studies. Further studies are required to reevaluate the epidemiology of PTLD in the modern era of transplant immunosuppression.
authors.affiliation: 1 Department of Nephrology and Transplantation, Beaumont Hospital, Dublin, Ireland. 2 Department of Pathology, Beaumont Hospital, Dublin, Ireland. 3 National Cancer Registry Ireland, Cork, Ireland.
authors.forename: John A
authors.initials: JA
authors.lastname: OʼRegan
authors.forename: Susan
authors.initials: S
authors.lastname: Prendeville
authors.forename: Jennifer Anne
authors.initials: JA
authors.lastname: McCaughan
authors.forename: Carol
authors.initials: C
authors.lastname: Traynor
authors.forename: Frank J
authors.initials: FJ
authors.lastname: OʼBrien
authors.forename: Francis L
authors.initials: FL
authors.lastname: Ward
authors.forename: Denis
authors.initials: D
authors.lastname: OʼDonovan
authors.forename: Claire
authors.initials: C
authors.lastname: Kennedy
authors.forename: Ecaterina
authors.initials: E
authors.lastname: Berzan
authors.forename: Sinead
authors.initials: S
authors.lastname: Kinsella
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Williams
authors.forename: Patrick
authors.initials: P
authors.lastname: OʼKelly
authors.forename: Sandy
authors.initials: S
authors.lastname: Deady
authors.forename: Harry
authors.initials: H
authors.lastname: Comber
authors.forename: Mary
authors.initials: M
authors.lastname: Leader
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Conlon
mesh_terms: D000293:Adolescent; D000328:Adult; D064591:Allografts; D020031:Epstein-Barr Virus Infections / Q000453:epidemiology / Q000276:immunology; D005260:Female; D006085:Graft Survival; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects; D015994:Incidence; D007494:Ireland / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000401:mortality; D008232:Lymphoproliferative Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000276:immunology / Q000401:mortality; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D066027:Transplant Recipients; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D007166:Immunosuppressive Agents