Relationship between rabbit anti-thymocyte globulin and development of PTLD and its aggressive form in renal transplant population

Hatem Ali,Karim Soliman,Ahmed Daoud,Ingi Elsayed,Tibor Fülöp,Ajay Sharma,Ahmed Halawa

doi:10.1080/0886022x.2020.1759636

Abstract

ABSTRACT: Introduction The aim of our study is to explore the relationship of rabbit anti-thymocyte globulin (R-ATG) on development of post-transplant lymphoproliferative disease (PTLD) and its aggressive forms (monomorphic PTLD and Hodgkin lymphoma) in renal transplant recipients. Methodology All patients diagnosed with PTLD post-renal transplant in the United States’ Organ Procurement and Transplantation Network from 2003 till 2013 and followed up till 2017 were retrospectively reviewed. Multi-variable logistic regression analysis assessed association of R-ATG to development of PTLD and its aggressive form. Results Risk of developing PTLD post renal transplant is 1.35%. In comparison to interleukin-2 blocker induction therapy, R-ATG is associated with increased risk of development of PTLD (Odds Ratio = 1.48, confidence interval ranges from 1.04 to 2.11, p = .02) and is associated with higher risk of development of aggressive PTLD (Odds Ratio = 1.83, confidence interval ranges from 1.001 to 3.34, p = .04). Conclusion We conclude that R-ATG induction is associated with a higher risk of PTLD and its aggressive form (monomorphic PTLD and Hodgkin lymphoma). Careful monitoring for development of PTLD in renal transplant recipients receiving R-ATG induction therapy is advised.

Highlights

The aim of our study is to explore the relationship of rabbit anti-thymocyte globulin (R-ATG) on development of post-transplant lymphoproliferative disease (PTLD) and its aggressive forms in renal transplant recipients
The aim of our study is to explore the relationship between R-ATG and development of PTLD and its aggressive forms in renal transplant recipients
All renal transplant patients registered in organ procurement and transplantation network (OPTN) from January 2003 until January 2013, received R-ATG or interleukin-2 receptor antagonist induction therapies and discharged on calcineurin inhibitors maintenance therapy were retrospectively reviewed

Summary

Introduction

The aim of our study is to explore the relationship of rabbit anti-thymocyte globulin (R-ATG) on development of post-transplant lymphoproliferative disease (PTLD) and its aggressive forms (monomorphic PTLD and Hodgkin lymphoma) in renal transplant recipients. Post-transplant lymphoproliferative disease (PTLD) is one of the most common cancers occurring after solid organ transplantation, accounting for almost 20% of all cancers [1,2] It is affected by the type and dose of immunosuppression regimens and is often associated with poor prognosis [3]. Rabbit anti-thymocyte globulin (R-ATG) has been reported to increase the risk of PTLD in solid organ transplant recipients and hematopoietic stem cell transplant (HSCT) [7,8,9]. According to the 2008 World Health Organization (WHO) classification there are 4 subtypes of PTLD: 1. Early hyperplastic lesions characterized by polyclonal B cell proliferation without malignant transformation presenting as infectious mononucleosis-like acute illness

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