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CNI withdrawal for post-transplant lymphoproliferative disorders in kidney transplant is an independent risk factor for graft failure and mortality.
- Source :
-
Transplant international : official journal of the European Society for Organ Transplantation [Transpl Int] 2014 Sep; Vol. 27 (9), pp. 956-65. Date of Electronic Publication: 2014 Aug 20. - Publication Year :
- 2014
-
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.<br /> (© 2014 Steunstichting ESOT.)
- Subjects :
- Adult
Aged
Antibodies, Monoclonal, Murine-Derived therapeutic use
Antineoplastic Agents therapeutic use
Calcineurin Inhibitors administration & dosage
Calcineurin Inhibitors therapeutic use
Creatine blood
Drug Substitution
Epstein-Barr Virus Infections mortality
Epstein-Barr Virus Infections pathology
Epstein-Barr Virus Infections therapy
Female
France epidemiology
Glomerular Filtration Rate
Graft Rejection epidemiology
Graft Rejection etiology
Graft Rejection prevention & control
Graft Survival
Humans
Immunocompromised Host
Immunosuppressive Agents administration & dosage
Immunosuppressive Agents therapeutic use
Kidney physiopathology
Lymphoproliferative Disorders mortality
Lymphoproliferative Disorders pathology
Lymphoproliferative Disorders therapy
Male
Middle Aged
Pancreas Transplantation
Postoperative Complications mortality
Postoperative Complications pathology
Postoperative Complications therapy
Proportional Hazards Models
Radiotherapy, Adjuvant
Renal Dialysis
Renal Insufficiency etiology
Renal Insufficiency mortality
Renal Insufficiency therapy
Retrospective Studies
Risk Factors
Rituximab
Young Adult
Calcineurin Inhibitors adverse effects
Epstein-Barr Virus Infections etiology
Immunosuppressive Agents adverse effects
Kidney Transplantation
Lymphoproliferative Disorders etiology
Postoperative Complications etiology
Subjects
Details
- Language :
- English
- ISSN :
- 1432-2277
- Volume :
- 27
- Issue :
- 9
- Database :
- MEDLINE
- Journal :
- Transplant international : official journal of the European Society for Organ Transplantation
- Publication Type :
- Academic Journal
- Accession number :
- 24964147
- Full Text :
- https://doi.org/10.1111/tri.12375