Complication Of Renal Transplantation Research Articles

ULTRASOUND DIAGNOSIS OF THE RENAL ARTERY STENOSIS IN A TRANSPLANTED KIDNEY IN THE EARLY POSTOPERATIVE PERIOD

In this clinical case, stenosis of a renal artery of transplant was detected in time by angiography using dynamic Doppler ultrasound control. The chosen treatment method allowed the restoration of arterial patency and thus renal graft function in the shortest possible time and with minimal trauma. However, due to the high risk of restenosis in the plastic area, continuous dynamic ultrasound monitoring and monitoring of the patient's creatinine level are required. The purpose of this presentation is to present a case of early detection of a postoperative complication by Doppler ultrasound, which made it possible to prevent vascular dysfunction, often leading to loss of the renal graft. Materials and Methods. In this article, we report a case of timely detection of renal artery stenosis by ultrasound in a patient, followed by confirmation by angiography and restoration of renal artery and graft function by endovascular balloon angioplasty. All major hemodynamic changes in Doppler ultrasound parameters characteristic of renal artery stenosis are described in this article. Results. Dynamic Doppler ultrasound monitoring and angiography allowed early detection of the described complication of renal transplantation. The optimal choice of treatment tactics allowed the restoration of arterial patency and renal graft function in the shortest possible time, thus preventing graft rejection. Conclusion. Our clinical case demonstrates the importance of the monitor in the assessment of renal perfusion. The outcome of kidney transplantation largely depends on the successful resolution of these issues, which determines the relevance.

Biopsy-proven BK virus nephropathy inrenal transplant recipients: A multi-central study from Turkey (BK-TURK STUDY).

BK polyomavirus infection is a challenging complication of renal transplantation. The management is not standardized and is based on reports from transplantation centers' experiences, usually with small sample sizes. Therefore, we aimed to present our countrywide experience with BK virus nephropathy (BKVN) in renal transplant recipients. Our study was carried out with the participation of 30 transplantation centers from all regions of Turkey. Only cases with allograft biopsy-proven BKVN were included in the study. 13,857 patients from 30 transplantation centers were screened, and 207 BK nephropathy cases were included. The mean age was 46.4± 13.1 years, and 146 (70.5%) patients were male. The mean time to diagnosis of BK nephropathy was 15.8±22.2 months after transplantation. At diagnosis, the mean creatinine level was 1.8± 0.7 mg/dL, and the mean estimated glomerular filtration rate was 45.8 ± 19.6 mL/min/1.73m2. In addition to dose reduction or discontinuation of immunosuppressive drugs, 18 patients were treated with cidofovir, 11 patients with leflunomide, 17 patients with quinolones, 15 patients with intravenous immunoglobulin (IVIG), 5 patients with cidofovir plus IVIG, and 12 patients with leflunomide plus IVIG. None of the patients receiving leflunomide or leflunomide plus IVIG had allograft loss. During follow-up, allograft loss occurred in 32 (15%) out of 207 patients with BK nephropathy. BKVN is still a frequent cause of allograft loss in kidney transplantation and is not fully elucidated. The results of our study suggest that leflunomide treatment is associated with more favorable allograft outcomes.

Transplant Renal Vein Stenosis (TRVS) Managed with Percutaneous Endovascular Stenting: A Case Report

Transplant renal vein stenosis (TRVS) is a rare vascular complication of renal transplant that can masquerade findings of rejection and infection. We report a case who presented 2 years 9 months post-transplant with localized non-tender heaviness and fullness at the graft site with renal dysfunction. Initial ultrasonogram (USG) was suggestive of graft pyelonephritis with perinephric collection, though, there were no clinical features of infection and cultures came as sterile. Doppler revealed findings of TRVS, which was confirmed with a CT angiogram. Graft vein angioplasty restored the hemodynamics, but the patient again presented after 4 months with incidentally detected graft dysfunction. USG Doppler showed graft vein stenosis at the same site, which was managed with an elective renal vein angioplasty with stent placement.

Particles versus Other Embolic Agents in Emergency Renal Artery Embolization, Various Indications And Techniques

Abstract Background Renal artery embolization (RAE) refers to the occlusion of the renal artery, or some of its branches, by injection of an embolic agent through an endovascular catheter. Aim and Objectives to compare various embolic agents such as metallic microcoils, microspheres (embospheres), polyvinyl alcohol (PVA), gelfoam and histoacryl in emergent indications and techniques for RAE in management of emergency renal diseases. Subjects and Methods This combined retrospective and prospective observational study was conducted at Egyptian Military Hospitals, Radiodiagnosis and Intervention departments, and Ain Shams hospitals. The study included 18 patients with clinical and radiological confirmation of symptomatic indications for urgent RAE from 2019 to 2022. The duration of the study was 3 years. Result small sample sized and emergent cases showing mean embolization time was 12.6 minutes with no detected recanalization nor post embolic syndrome. Conclusion Renal artery embolization has become an effective, versatile therapeutic and adjuvant tool for many urologic conditions, both acute and chronic. It can be applied successfully in improving preoperative management of renal tumors prior to nephrectomy, achieving hemostasis in cases of hemorrhage from trauma or from tumors such as angiomyolipomas, treating complications of renal transplantation and biopsies such as arteriovenous fistulas and pseudoaneurysms, improving symptoms in patients with arteriovenous malformations and certain chronic renal parenchymal diseases, and for treating renal artery aneurysms.

Contrast-enhanced US in Renal Transplant Complications: Overview and Imaging Features.

Renal transplant is the first-line treatment of end-stage renal disease. The increasing number of transplants performed every year has led to a larger population of transplant patients. Complications may arise during the perioperative and postoperative periods, and imaging plays a key role in this scenario. Contrast-enhanced US (CEUS) is a safe tool that adds additional value to US. Contrast agents are usually administered intravenously, but urinary tract anatomy and complications such as stenosis or leak can be studied using intracavitary administration of contrast agents. Assessment of the graft and iliac vessels with CEUS is particularly helpful in identifying vascular and parenchymal complications, such as arterial or venous thrombosis and stenosis, acute tubular injury, or cortical necrosis, which can lead to graft loss. Furthermore, infectious and malignant graft involvement can be accurately studied with CEUS, which can help in detection of renal abscesses and in the differentiation between benign and malignant disease. CEUS is also useful in interventional procedures, helping to guide percutaneous aspiration of collections with better delimitation of the graft boundaries and to guide renal graft biopsies by avoiding avascular areas. Potential postprocedural vascular complications, such as pseudoaneurysm, arteriovenous fistula, or active bleeding, are identified with CEUS. In addition, newer quantification tools such as CEUS perfusion are promising, but further studies are needed to approve its use for clinical purposes. ©RSNA, 2024 Supplemental material is available for this article.

Salvaging External Iliac Artery Dissection during Renal Transplant: A Case Series

External iliac artery dissection is a rare and reversible but serious complication of renal transplant that may ultimately lead to loss of kidney and lower limb. The exact cause of dissection is not known but atherosclerosis, imperfect suturing techniques, and clamp trauma are associated with increased risk. Here, we report three successful cases of vascular repair of external iliac artery dissection during renal transplant by Dacron interposition graft and reanastomosis.

Significance of nuclear medicine methods for diagnosis and predicting the course of renal transplantation complications

Renal transplantation is a replacement-based therapeutic method in end-stage kidney failure.It is based on the interdisciplinary collaboration between scientists and clinicians, which match together the achievements of surgery, immunology, and radiation diagnostics. After transplantation the complications appear, which can be associated with status of the graft, the immunological factors of compatibility between the donor and the recipient, the surgical intervention. Early diagnosis and forehanded treatment of such complications is important, as it helps to evaluate and predict the functionality of the graft. In this article we discuss the complications after kidney transplantation: the reasons of their occurrence, pathogenesis, clinical features, and radiation imaging signs. The opportunities of the radiology methods for the differential diagnostics of complications which appear before, during or after the surgery, are shown. We pay the main attention to the nuclear medicine methods, especially the dynamic renal scintigraphy (DRSG) as a method for the evaluation of graft functionality. This is a safe, accessible and non-invasive method for evaluation the quantitative and qualitative parameters of kidney function. DRSG consequently characterizes the perfusion, the extraction and the excretion in the studied organ. We display the standard DRSG protocols using [99mTc] Tc-MAG3 and [99mTc] Tc-DTPA radiopharmaceuticals. We analyze investigations of kinetic perfusion and parenchymal DRSG parameters and their importance for differential diagnosis of complications, prognosis on delayed and slow graft function, short-term and long-term graft functionality assessment. We make an accent on the prognostic importance of the dynamic changes visible on DRSG. We discuss the perspectives of further development of scintigraphic methods for the assessment of kidney grafts. It is related to the implementation of high-quality 3-dimentional visualization, newest radiopharmaceuticals. We conclude the importance of the nuclear medicine as an element of multidisciplinary approach in transplantology.

Урологические осложнения трансплантированной почки.

Introduction. Renal transplantation is the standard of medical care in the treatment of patients with end-stage chronic kidney disease. It increases patient survival in the next five years by 87-93%. Urological complications after transplantation remain one of the main problems – on average they amount to 4-14%. Material and methods. We searched for publications in the PubMed and eLibrary databases using the keywords «kidney transplantation», «urological complications», «post-transplantation period», «urinary leakage», «ureteral stricture», «vesicoureteral reflux». As a result of the search, 57 sources were selected that were used when writing the literature review. Results. By reviewing various studies of complications in the post-transplant period, we identify and characterize the main urological complications of renal transplantation, such as urine leak, hematuria, ureteral stricture, kidney stones and vesicoureteral reflux. The article also reflects the ways of correcting these complications. Conclusions. The analysis showed that proper preoperative urological evaluation of the recipient and correction of urodynamic disorders are crucial to prevent the development of complications; the survival of the transplant directly depends on a multidisciplinary team approach to kidney transplantation and the inclusion of a urologist in the pre- and postoperative monitoring of the patient.

Effects of an Educational Package on Quality of Life and Acute Complications in Kidney Transplant Recipients: A Clinical Trial

Background: Patients with chronic renal failure face many challenges in self-care after a kidney transplant. This treatment method affects their quality of life and leads to multiple complications. Objectives: This study aimed to evaluate the impact of an educational package on the quality of life (QoL) and complications of renal transplant recipients. Methods: This clinical trial was conducted on 72 patients (control and intervention groups) who had undergone kidney transplantation for the first time. The intervention involved an educational package comprised of five sessions. Besides, an educational booklet, weekly telephone calls, and follow-up (8 weeks after the intervention) were protablevided. The data were collected by the Kidney Transplant Questionnaire (KTQ-25) completed before and after the intervention by the two groups, and the Renal Transplantation Complications Checklist completed after 8 weeks. Data analysis was performed in each group before and after the intervention and between the two groups after the intervention via chi-square, Fisher’s exact test, paired t-test, and independent t-test. Results: The results showed a significant difference between the intervention and control groups in the physical dimension (P = 0.002). No significant difference was observed between the two groups in the remaining dimensions and the overall QoL. A significant difference was found between the two groups in terms of infection (P = 0.04), but no difference was observed between the two groups in terms of re-admission and transplant rejection (P > 0.05). Conclusions: The educational package affected all dimensions of QoL, especially the physical dimension and infection (as an acute complication of renal transplant); it improved QoL and reduced infection in the intervention group. Therefore, this package can be considered in the management plans of renal transplant recipients. Administration of this package can help understand the patients’ needs and requests and improve their health-related behaviors.

Histiocytic sarcoma in renal transplant patients: a literature review

BackgroundHistiocytic sarcoma (HS) is defined as neoplasm resembling morphological and immunophenotypic characteristics of mature histiocytes. It is a rare form of lymphoid neoplasms. Despite advances in treatment and diagnosis of histiocytic sarcoma, majority of cases had poor prognosis due to progressive nature of the disease. In the following article, all reported cases of histiocytic sarcoma in renal transplant patients are reviewed.MethodsIn our literature review, all relevant reports were collected electronically by entering the necessary keywords. A Boolean approach using Medical Subject Heading (MeSH) keywords was implemented. After establishing the inclusion/exclusion criteria, article titles and abstracts were evaluated by Systematic Reviews and Meta-Analyses (PRISMA) standards for 2020. All cases of histiocytic sarcoma in renal transplant patients were included.ResultBased on our inclusion and exclusion criteria 4 case reports were yielded in this review. Two were males and 2 were females with the mean age of 42.25 years. Fever was the most common symptom. Although tumor originated from the native kidney on one patient, the site of the primary tumor was thorax, oropharynx, and transplanted kidney in the rest. Metastasis was detected in all cases. Prednisone was used for all cases. EBV was positive in 2 cases and negative in one of them. Histology was diagnostic and similar in all cases. Immunohistochemistry was done for 3 cases. Although chemotherapy was done for 3 patients, all 4 cases ended in mortality.ConclusionDespite the fact that neoplasms are post renal transplant complications, histiocytic sarcoma is a scarce and fatal entity in such patients. Histological and immunohistochemistry tests are the corner stone in diagnosis of histiocytic sarcoma.

Single-port robotic-assisted ureteral reconstruction for management of strictures after renal transplantation

Ureteral strictures are a common and often challenging complication of renal transplantation. The use of single-port (SP) robotic-assisted laparoscopic surgery is a novel approach in the management of these patients. Here we describe 3 patients with stricture of the transplant ureter causing hydronephrosis and allograft dysfunction, whose ureteral reconstructions were successfully performed using the SP robotic-assisted laparoscopic approach. Two patients underwent transplant-to-native ureteroureterostomy and 1 patient underwent ureteroneocystostomy. We demonstrate that the use of concurrent ureteroscopy and near-infrared fluorescence enables safe and rapid identification of native and transplant ureters. In addition, side-to-side anastomosis of transplant-to-native ureters allows for preservation of ureteral vasculature. In this limited series, the SP robotic platform demonstrates great promise in simplifying and streamlining our approach to ureteral strictures in this patient population.

Vascular complications of renal transplantation: Risk factors and impact on graft survival

Vascular complications of renal transplantation: Risk factors and impact on graft survival

Outcome of Renal Transplantation at Ahmed Gasim Cardiac and Renal Transplant Centre in Sudan-2014

Background: Although not life-saving procedures like liver or heart transplantation, renal transplantation is the preferred treatment for many patients with end-stage renal disease because it improves patients’ quality of life, while other forms of renal replacement therapy (RRT) such as haemodialysis (HDX) shown to regain only 10% of the patient’s renal function [1]. Transplantation releases patients from the dietary and fluid restrictions and the physical constraints imposed by other forms of (RRT), patients become able to return to their normal activities. Patient’s 5-year survival is higher post transplant. Patients and methods: This is Descriptive, retro-prospective, cross sectional analytic and multicentre study done in Ahmed Gasim Cardiac and Renal Transplant Centre including 105 patients. After meeting the Inclusion Criteria and exclusion Criteria, then cases were selected and written in constructed questionnaire. The aim of the study was to evaluate the outcome of renal transplantation in Sudan. Results: 105 cases were used with male predominate and ratio male to female ratio 3:1, the main age of presentation between 31 - 45 years, most of the patients discharge uneventful with good outcome. During one-year follow-up following renal transplantation. Patient survival 95.2 % graft survival 82.4%. Overall morbidity shows 70.5%. Conclusion: this study showed that the one-year patient survival of 95.2%. Actuarial one-year graft survival of 92.4%. Renal transplantation complications can be reduced by meticulous preoperative workup including good cardiovascular assessment, tissue mismatch and BMI good postoperative follow up for early detection of graft rejection and long-term complications and finally patient education.

Renal Transplant Complications—A Pictorial Review

AbstractRenal transplantation is the most effective treatment for end-stage renal disease, with advanced immunosuppressive therapy and better surgical techniques resulting in better survival of the graft. Despite the advances, complications do occur in the postoperative period and timely diagnosis of the complications is vital for prompt management and salvage of the transplant. This pictorial essay aims to classify the complications of renal transplantation, describe the various imaging modalities used to detect complications, and provide a brief overview of the role of interventional radiology in their management. The complications can be broadly divided into perinephric fluid collections, vascular, collecting system, and parenchymal complications. Imaging including ultrasonography, computed tomography, magnetic resonance imaging, and newer methods like elastography, magnetic resonance imaging arterial spin labeling, diffusion-weighted imaging, diffusion kurtosis imaging, blood oxygenation-level dependent, and magnetic resonance elastography can be used in the diagnosis of these complications. Interventional radiology has advanced a lot in managing them; hence, interventional techniques can be the first choice of treatment in institutions where robust interventional radiology setup is available.

Multimodality Radiological Diagnosis of Post Renal Transplantation Complications

Multimodality Radiological Diagnosis of Post Renal Transplantation Complications

344.7: Early Post-operative Thrombotic Microangiopathy in Deceased Donor Kidney Transplant: Case Series

Background: Transplant associated thrombotic microangiopathy (TA-TMA) is well recognized as a serious complication of renal transplantation. TA-TMA is characterized by injury of arterioles and capillaries and encompasses syndromes of thrombocytopenia, microangiopathic hemolytic anemia(MAHA) and variable degrees of kidney graft dysfunction. TA-TMA can be classified into recurrent TMA (from underlying complement mutations) and de novo TMA. The incidence of de novo TMA ranges from 3-14%. Causes of de novo TMA include immunosuppressive drugs (tacrolimus, mTOR inhibitors, valgancyclovir), ischemia reperfusion injury, viral infections (CMV, Parvovirus B19, HIV, HHV-6) and antibody-mediated rejection. We have found that many of these cases also have very low levels of ADAMTS13 but do not meeting clinical criteria for TTP. If the latter is secondary to endothelial damage vs consumption process is still unknown. Objective: The purpose of this study was to identify if any specific risk factors or variables are associated with TA-TMA in the setting of deceased donor kidney transplantation (DDKT). Methods: We retrospectively collected data on 11 patients who were diagnosed with TA-TMA in the immediate post operative period (defined as less than 2 weeks from transplant date) since January, 2017. We analyzed donor characteristics including age, type of deceased donor, last known platelet count, biopsy features, pump parameters, cold ischemia time (CIT), warm ischemia time (WIT), reperfusion injury (RI) described at transplant surgery. Recipient variables included baseline platelet count on admission, the post-op day of diagnosis and at resolution (defined as platelet count > 100K and no need for additional transfusion), the use of thymoglobulin, ADAMS13 activity, changes in maintenance immunosuppression, evidence of post op bleeding, delayed graft function (DGF) and its recovery, and renal function at 1 and 3 months post transplant (Table). Results: 72% of the kidneys were from donation after cardiac death donors (DCD). The mean arterial pressure on the perfusion pump was 39 ± 7 mmHg and the flow was 148 ± 35 ml/sec. 81 % of the donor biopsies showed mild ATN, 72% had evidence of atherosclerosis and 54% of fibrosis and only one showed fibrin thrombi in the glomerulus. The mean CIT and WIT were 1913 ± 423 and 27 ± 32 min, respectively. The mean donor platelet count and baseline recipient’s platelet count were 209 ± 210 and 166 ± 71 x 10(3)/mcl, respectively. The TA-TMA event occurred on post op day 3± 1.3 with a mean platelet count of 45 ± 19 x 10(3)/mcl. ADAMTS 13 level was <10% in 54% of the cases and LDH level 2880 ± 55 U/L. 3 patients received FFP infusions, 5 received plasmapheresis and 3 received conservative treatment. The microangiopathic hemolytic anemia recovered in 10 ± 2.4 days to a platelet count of 130 ± 67 x 10(3)/mcl. There were 6 cases of post op bleeding (55%) with 4 requiring surgical intervention and 4 cases of RI (36%). Of the 8 patients that sustained DGF, 6 recovered at one month, one recovered at 3 months post transplant (having history of low C3 and late biopsy proven TMA) and one died. The mean SCr and eGFR at 1 and 3 months were 2± 1.1, 51 ± 34 and 1 ± 0.5 mg/dl and 66± 30 ml/min, respectively.There were no statistical differences on the above parameters when the patients were grouped by the presence of post operatory bleeding. However, when we added the reperfusion injury factor, we found a lower ADAMTS 13 levels of 17 ±7 UI/dl in the non bleeding group who sustained RI (60%) vs 21± 37 UI/dl in the bleeding group who had only one patient with RI (17%) (p=0.24). Conclusions: TA-TMA in the immediate postoperative period can be difficult to diagnose and treat. Our findings demonstrated that 55% of the cases were associated with post operatory bleeding leading to the reduction of ADAMTS 13 levels, most likely by platelet consumption. 36% were related to reperfusion injury where the consumption of ADAMTS 13 could be explained by direct endothelial damage. None of the patients needed other than conservative therapy. This data needs to be correlated in a larger cohort. In this context we are planning to prospectively study ADAMTS 13 activity in the immediate post kidney transplant period.

Contrast Enhanced Ultrasound Compared with MRI and CT in the Evaluation of Post-Renal Transplant Complications.

Renal transplantation (RT) is the treatment of choice for end-stage renal disease, significantly improving patients’ survival and quality of life. However, approximately 3–23% of patients encounter post-operative complications, and radiology plays a major role for their early detection and treatment or follow-up planning. CT and MRI are excellent imaging modalities to evaluate renal transplant post-operative course; nevertheless, they are both associated with a high cost and low accessibility, as well as some contraindications, making them not feasible for all patients. In particular, gadolinium-based contrast can lead to the rare condition of nephrogenic systemic fibrosis, and iodine-based contrast can lead to contrast-induced nephropathy (CIN). CT also exposes the patients who may require multiple examinations to ionizing radiation. Therefore, considering the overall advantages and disadvantages, contrast-enhanced ultrasound (CEUS) is presently considered an effective first-line imaging modality for post-operative early and long-term follow-up in RT, reducing the need for biopsies and providing adequate guidance for drainage procedures. Hence, this paper aims to review the updated knowledge on CEUS compared with CT and MRI for the evaluation of RT renal transplant complications; advantages, limitations, and possible recommendations are provided.

Vascular Complications in Renal Transplantation: Surgical Salvage of Renal Artery Dissection.

Vascular Complications in Renal Transplantation: Surgical Salvage of Renal Artery Dissection.

Pull-Through Ureteroneocystostomy for Very Small En Bloc Kidney Transplants from Donors Weighing ≤ 5 kg

Background: Urologic complications are the most dreaded complications of renal transplantation, particularly when pediatric en bloc kidneys (EBKs) are used. Current techniques of ureteroneocystostomy (UNC) are not applicable to the very small ureters of very small en bloc kidneys. We reviewed our experience with the pull-through ureteroneocystostomy in kidney transplantation from donors under or equal to 5 kg weight. Material and Methods: The technique was used in 32 EBKs. Complications and 4-year graft survival are discussed. Results: One single graft thrombosed and required nephrectomy. The remaining kidneys provided good renal function. Hematuria was transient in five patients and did not require fulguration. No leakage was experienced. Delayed graft function occurred in 16% of cases. No primary nonfunction was noted. During the follow-up period, hydronephrosis and/or pyelonephritis were not observed. The 4-year graft survival was 95% with serum creatinine levels averaging 0.9 mg/dl. Conclusions: The procedure proved to be safe and reproducible. It can be applied to the ureteral re-implantation of very small EBKs.

MO993: Incidence of Ptld and Its Relationship with Cmv-Serostatus Positivity Among Childhood and Adulthood Population: A Registry Data Study

Abstract BACKGROUND AND AIMS It is unknown how the epidemiology of post-transplant lymphoproliferative disease (PTLD) and its relationship with CMV infection differ between adult and pediatric kidney transplant recipients. In addition, with current advancements in immunosuppressive therapy, the incidence of PTLD has changed dramatically. The aim of our study is to elucidate the relationship between PTLD and CMV infection. Moerover, to assess the incidence of PTLD among Adult and pediatric renal transplant patients in the current era. METHOD All renal transplant patients registered in the Organ Procurement and Transplantation Network between 2005 and 2019 were retrospectively reviewed. Patient were followed up till December 2020. Patients who had multiple organ transplant or those with previous renal transplants were excluded from the study. Data about recipient factors (age, sex ethnicity, diabetes, CMV serostatus, and EBV serostatus), donor factors (living or deceased), transplant factors (PRA, Cold ischemia time, HLA mismatches, induction and immunosuppressive therapy) were reviewed. Incidence rate of PTLD at one year and five years post-transplant were calculated among the Adult and Pediatric population. Univariate and Multivariate cox-hazard regression models were performed to assess the relationship between CMV serostatus and occurrence of PTLD. RESULTS About 10 947 pediatric renal transplant patients were included. About 315 pediatric patients developed PTLD during the follow-up time (2.88%). About 50.55% of PTLD occurred within the first-year post-transplant. 60% occurred within two-year post-transplant, while 80.63% of them occurred within five years post-transplant. CMV recipient infection was not associated with PTLD occurrence in the pediatric population (HR = 0.88, Pvalue = 0.81, 95% confidence interval ranged between 0.66 and 1.18). Proportional hazard assumption was not violated with P = 0.55. Among the adult population, 1990/277 955 developed PTLD (0.77%). About 25.77% of PTLD among the adult population occurred within the first-year post-transplant. About 39.39% of PTLD in the adult occurred within two-year post-transplant. About 66.55% of PTLD in the adult occurred within five-years post-transplant. CMV recipient positive serostatus was associated with a protective effect against occurrence of PTLD (HR = 0.82, Pvalue &amp;lt;0.01, 95% confidence interval ranged between 0.73 and 0.94). The most common type of PTLD among the pediatric and adult population was monomorphic PTLD ( 40% and 34%, respectively). CONCLUSION PTLD is a rare complication of renal transplantation in the current era. The risk of development of PTLD is highest during the first-year post-transplant. CMV recipient positive serostatus has a protective effect against development of PTLD.