Treatment of post-transplant lymphoproliferative disorders in kidney transplant recipients: a single-center retrospective analysis.

Abstract

Post-transplant lymphoproliferative disorder (PTLD) is a significant complication of immunosuppression after kidney transplantation and has no established standard therapy. Achieving favorable treatment outcomes and preserving renal function in patients with PTLD remains challenging, particularly when the central nervous system (CNS) is involved. Here we describe our experience with 8 patients who developed PTLD after kidney transplantation at our institution. Diffuse large B-cell lymphoma was the most common histological subtype, observed in 5 patients (62.5%). Epstein-Barr Virus infections were observed in 7 patients (87.5%), CNS involvement in 5 patients (62.5%) and gastrointestinal tract involvement in 3 patients (37.5%). With a median follow-up of 55.3 months, the 4-year overall survival rate was 72.9%. Seven patients (87.5%) achieved complete remission (CR), and 5 maintained CR as of the last follow-up visit. In the CNS involvement group, patients treated with aggressive chemotherapy died of sepsis, and those treated with a combination of rituximab, whole-brain radiation therapy, and reduction of immunosuppression achieved long-term progression-free survival without reinstitution of dialysis or neurological toxicity. The clinical courses of these 8 kidney transplant recipients who developed PTLD, most of whom had CNS involvement, suggest that long-term remission may be achievable without systemic chemotherapy.