Treatment of post-transplantation lymphoproliferative disorders after kidney transplant with rituximab and conversion to m-TOR inhibitor.

John Fredy Nieto Rios,Lina María Serna Higuita,Kenny Mauricio Gálvez Cárdenas,Gustavo Adolfo Zuluaga Valencia,Catalina Ocampo Kohn,Arbey Aristizabal Alzate,Sandra Milena Gómez De Los Ríos

doi:10.25100/cm.v47i4.1989

Abstract

Background: Post-transplantation lymphoproliferative disorders are serious complications of organ transplantation which treatment is not yet standardized. Objective: To describe the clinical response, overall and graft survival of patients in our center with this complication after kidney transplantation, which received rituximab as part of their treatment as well as conversion to m-TOR. Methods: Retrospective study, which included patients, diagnosed with post-transplant lymphoproliferative disorders after kidney transplantation from January 2011 to July 2014. Results: Eight cases were found with a wide spectrum of clinical presentations. Most had monomorphic histology, 85% were associated with Epstein-Barr virus, 25% of patients had tumor involvement of the renal graft, and 12.5% had primary central nervous system lymphoma. All patients were managed with reduction of immunosuppression, conversion to m-TOR (except one who lost the graft at diagnosis) and rituximab-based therapy. The overall response rate was 87.5% (62.5% complete response, 25% partial response). Survival was 87.5% with a median follow-up of 34 months. An additional patient lost the graft, with chronic nephropathy already known. All the remaining patients had stable renal function. Conclusions: There are no standardized treatment regimens for lymphoproliferative disorders after kidney transplantation, but these patients can be managed successfully with reduction of immunosuppression, conversion to m-TOR and rituximab-based schemes.

Highlights

IntroductionThe first cases of post-transplantation lymphoproliferative disorder (PTLD) were published by Penn et al, in 1969 in five patients who received a living donor kidney transplant[1 ]; and since it remains as one of the complications of higher morbidity and mortality associated with solid organ transplantation
The first cases of post-transplantation lymphoproliferative disorder (PTLD) were published by Penn et al, in 1969 in five patients who received a living donor kidney transplant[1 ]; and since it remains as one of the complications of higher morbidity and mortality associated with solid organ transplantation.The term PTLD encompasses a heterogeneous group of lymphoproliferative disorders that may occur after transplantation of solid organs and hematopoietic cells[2 ]
Lymphoproliferative disorders after kidney transplantation, but these patients Conclusiones: No existen esquemas estandarizados de tratamiento can be managed successfully with reduction of immunosuppression, para la enfermedad linfoproliferativa post-trasplante renal, pero estos conversion to m-TOR and rituximab-based schemes

Summary

Introduction

The first cases of post-transplantation lymphoproliferative disorder (PTLD) were published by Penn et al, in 1969 in five patients who received a living donor kidney transplant[1 ]; and since it remains as one of the complications of higher morbidity and mortality associated with solid organ transplantation. The term PTLD encompasses a heterogeneous group of lymphoproliferative disorders that may occur after transplantation of solid organs and hematopoietic cells[2 ]. Survival rates are difficult to compare given the broad clinical and histological spectrum, and they depend on the transplanted organ and the localization pattern. Post-transplantation lymphoproliferative disorders are Antecedente: La enfermedad linfoproliferativa post-trasplante es serious complications of organ transplantation which treatment is una complicación grave del trasplante de órganos cuyo tratamiento not yet standardized.

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Discussion

Conclusion