Outcome Of Rapamycin Therapy For Post Transplant- Lymphoproliferative Disorder After Kidney Transplantation: Case Series

   Post transplant  lymphoproliferative  disorders (PTLD) , are  a   complication of chronic  immunosuppressive  therapy  in  solid organ  transplantation with a  high mortality  rate. Alternative treatments such as rapamycin have been explored.

    A detailed retrospective analysis was performed according to data collected from thirteen patients with PTLD.  At the time of PTLD diagnosis, immunosuppressive therapy was decreased and rapamycin administered. Overall survival and disease free survival of patients and graft survival were determined.

Among 590 kidney transplant recipients, thirteen adult patients with PTLD were included in this study. The mean age of the patients was 42.15 (range: 25-58) years at the time of PTLD diagnosis, and 9 patients were male. Histology was distributed in 9 diffuse large B cell, 1 Malt lymphoma, 1 Burkitt lymphoma, 2 Hodgkin-like PTLD. The response rate to rapamycin alone was 30.8%. The mean overall survival period is 27.4 months with 9 patients still living. In total, 10 patients (76.9%) achieved a complete remission, with functioning graft in 11 (84.6%) patients.

Despite to retrospective and limited number of patients, this study provides promising results regarding the effectiveness of stopping calcineurin inhibitors and switching to rapamycin for patients with PTLD.

Table 1

Patient characteristics at diagnosis of PTLD

DLBCL: diffuse large B cell lymphoma , EBV: Epstein-Barr virus , CNI: calcineurin inhibitor , mos :  months ,

PTLDpost transplant lymphoproliferative disorders, CsA:  cyclosporin A , MMF:mycophenolate mofetil ,  Aza: Azathioprine.Tac: tacrolimus, LN: lymphnode, LAP: lymphadenopathy

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Table 2

outcome and response to treatment

PRpartial disease remission; CR: complete disease remission; D :death; RAPA: rapamycin , NR: no response , R-CHOP: rituximab-cyclophosphamide, doxorubicin, vincristine, prednisone, and etoposide,  mos: months

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No relevant conflicts of interest to declare.