Post-Transplant Lymphoproliferative Diseases after Renal Transplantation. Long Term Experience over 35 Years in Peru.

BACKGROUND: Post-transplant lymphoproliferative diseases (PTLD) are a combination of diseases characterized by the proliferation of lymphoid cells that occur in the context of post-transplant immunosuppression. Primary infection by Epstein Barr Virus (EBV) is the main risk factor for the development of PTLD. A total of 11% of all the cancers recorded in renal transplant recipients are PTLD.

OBJECTIVE: To determine prevalence of PTLD in renal transplant recipients.

PATIENTS AND METHODS: We retrospectively reviewed the records of 1038 renal transplant recipients who received allograft transplants between 1972 and 2007 and recorded the incidence and types of de novo malignancies that developed in these patients. The study was carried out from two centers in Peru.

RESULTS: Forty-seven neoplasms were diagnosed in 43 recipients. 26 were men and 16 women, mean age was 46.0, range (17–67 years). Malignancy was diagnosed 2 to 240 months after transplantation. The tumors included Kaposi’s sarcoma (KS) in ten patients, squamous cell carcinoma (SCC) in seven, basal cell carcinoma (BCC) in six, cervix cancer in four, colon and breast cancer in three and hepatocarcinoma in two .Also were reported one case of small intestine cancer, osteosarcoma, pancreatic cancer, lung cancer, bladder cancer, schwanoma, melanoma, tongue cancer, pelvis renal cancer and carcinomatosis from unknown primary. PTLD were 4.2% (two cases) from all neoplasm found in renal transplant patients. First case corresponds a female 53 years old with four year from renal transplant. ATG, ALG OKT3 were not used in the patient during transplant induction. She was receiving cyclosporin and azatrioprine as inmunosupresors. She had a bulky diffuse large B cell lymphoma primary from retroperitoneal node, stage IVB, IPI high risk and bone marrow involved. She received CHOP-21 regimen for four cycles with progressive disease. She died from meningeal involvement, six months after from diagnosis. Second case was a male, 74 years old with ten years from renal transplant. He has a diffuse large B cell lymphoma from neck skin, stage IB. ATG, ALG OKT3 were not used in the patient during transplant induction. He was receiving cyclosporine and azathioprine as inmunosupresors, currently the patient continues CHOP-21 regimen with good response.

Conclusions: A low incidence of PTLD after renal transplantation occurred in Peru.