CNI withdrawal for post‐transplant lymphoproliferative disorders in kidney transplant is an independent risk factor for graft failure and mortality |
| |
| Authors: | Nolwenn Rabot Matthias Büchler Yohann Foucher Anne Moreau Celine Debiais Marie‐Christine Machet Michelle Kessler Emmanuel Morelon Antoine Thierry Christophe Legendre Joseph Rivalan Nassim Kamar Jacques Dantal |
| |
| Institution: | 1. Department of Nephrology Transplantation, H?pital Bretonneau, Tours University Hospital, , Tours, France;2. SPHERE Laboratory (EA 4275), Nantes University Hospital, INSERM U1064, , Labex Transplantex, France;3. Department of Pathology, Nantes University Hospital, , Nantes Cedex, France;4. Department of Pathology, H?pital La Milétrie, Poitiers University Hospital, , Poitiers Cedex, France;5. Department of Pathology, H?pital Bretonneau, Tours University Hospital, , Tours, France;6. Department of Nephrology, H?pitaux de Brabois, Nancy University Hospital, , Vand?uvre‐lès‐Nancy, France;7. Department of Nephrology and Transplantation, Hospices Civils de Lyon, Edouard Herriot Hospital, , Lyon Cedex, France;8. Department of Nephrology Transplantation, H?pital La Milétrie, Poitiers University Hospital, , Poitiers Cedex, France;9. Department of Adult Kidney Transplantation, AP‐HP Necker, Inserm U845, , Paris, France;10. Department of Nephrology, Pontchaillou Hospital, Rennes University Hospital, , Rennes, France;11. Department of Nephrology, Dialysis and Organ Transplantation, CHU Rangueil, , Toulouse, France;12. INSERM U1043, IFR–BMT, CHU Purpan, , Toulouse, France;13. Université Paul Sabatier, , Toulouse, France;14. Institut de Transplantation Urologie et Néphrologie, ITUN, Nantes University Hospital, , Nantes Cedex, France |
| |
| Abstract: | Post‐transplantation lymphoproliferative disorders (PTLD) are associated with poor patient and graft survival. The risk of rejection and subsequent graft loss are increased by the reduction of immunosuppression therapy, the cornerstone of PTLD treatment. This multicentre, retrospective, nonrandomized cohort study includes 104 adults who developed PTLD after renal or simultaneous renal/pancreatic transplantation between 1990 and 2007. It examines the effect of calcineurin inhibitor (CNI) withdrawal on long‐term graft and patient survival. At 10 years postonset of PTLD, the Kaplan–Meier graft loss rate was 43.9% and graft loss or death with functioning graft was 64.4%. Cox multivariate analysis determined risk factors of graft loss as PTLD stage greater than I‐II and CNI withdrawal, and for graft loss and mortality, these remained risk factors along with age over 60 years. Type and location of PTLD, year of diagnosis, and chemotherapy regime were not independent risk factors. Multivariate analysis determined CNI withdrawal as the most important risk factor for graft loss (HR = 3.07, CI 95%: 1.04–9.09; P = 0.04) and death (HR: 4.00, CI 95%: 1.77–9.04; P < 0.001). While long‐term stable renal function after definitive CNI withdrawal for PTLD has been reported, this review determined that withdrawal is associated with reduced graft and patient survival. |
| |
| Keywords: | calcineurin inhibitor graft survival immunosuppression withdrawal kidney transplant post‐transplant lymphoproliferative disorder |
|
|
