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Lymphoproliferative disorders in Oxford renal transplant recipients

¹ Department of Anatomical Pathology, Stellenbosch University, Cape Town 7700, South Africa
² Nuffield Department of Surgery, John Radcliffe Hospital, Oxford OX3 9DU, UK
³ Department of Forensic Medicine, Natal University, Durban 4013, South Africa
⁴ Department of Pathology, Natal University
⁵ Nuffield Department of Clinical Laboratory Sciences, John Radcliffe Hospital
⁶ Department of Cellular Pathology, John Radcliffe Hospital

Correspondence to:
Professor K C Gatter, Nuffield Department of Clinical Laboratory Sciences, Level 4, Academic Block, John Radcliffe Hospital, Oxford OX3 9DU, UK;
kevin.gatter{at}ndcls.ox.ac.uk Background: Increased cancer incidence, particularly lymphoproliferative disease, is a complication of immunosuppression in organ transplantation. Non-Hodgkin’s lymphomas (NHLs) occur frequently during the first year after transplantation, more so in North America than in Europe.

Methods: This study audited and correlated the demographic, clinical, pathological, and outcome features of post-transplant lymphoproliferative disorders (PTLDs) in a large centre in Oxford, and assessed whether the time of onset fitted more with the European or North American pattern.

Results: There were 1383 renal transplants in the study period and 27 patients developed lymphoma: 26 NHLs and one Hodgkin’s disease (1.95%). Four of the patients never received cyclosporin. The mean time of diagnosis after transplant was 46 months. Most tumours (21/27) presented extranodally. Management included reduction of immunosuppression, surgical excision, antiviral treatment, radiotherapy, and chemotherapy. Three patients presented in the first post-transplant year—0.34% of cyclosporin managed patients—similar to the North American incidence, although the incidence of extranodal late PTLDs was also high (mean onset, 36 months v 15 months international mean). Post-transplant lymphomas were the most common malignancy associated with death in transplant patients.

Conclusions: PTLDs occurred in 2% of renal transplant patients, presenting both in the first year in association with cyclosporin use, as in North America, but also in subsequent years, giving an overall presentation time later than the international mean. The disease usually presented extranodally, accounting for the wide range of symptoms and signs. Despite awareness and active management, the disease contributed to death in more that 50% of patients with PTLDs.

Keywords: lymphoproliferative; disorders; renal; transplants

Abbreviations: CNS, central nervous system; CyA, cyclosporin; EBV, Epstein-Barr virus; NHL, non-Hodgkin’s lymphoma; PTLD, post-transplant lymphoproliferative disease; REAL, revised European American lymphoma