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Retransplantation After Post-Transplant Lymphoproliferative Disorders: An OPTN/UNOS Database Analysis

2006; Elsevier BV; Volume: 6; Issue: 11 Linguagem: Inglês

10.1111/j.1600-6143.2006.01543.x

1600-6143

Scott R. Johnson, Wida S. Cherikh, H. Myron Kauffman, Martha Pavlakis, Douglas W. Hanto,

Transplantation: Methods and Outcomes

Post-transplant lymphoproliferative disorders (PTLD) are a life-threatening complication of immunosuppressive therapy. Retransplantation of survivors remains controversial. The Organ Procurement and Transplant Network/United Network for Organ Sharing database was reviewed for individuals who developed PTLD and underwent retransplant from 1987 through 2004. Sixty-nine retransplants have been performed: 27 kidney, 22 liver, 9 lung, 6 heart, 4 intestine and 1 pancreas. At first transplant, most subjects (63.8%) were <17 years of age and was similar at retransplant with 50.7% less than 17 years. Time from transplant to PTLD was 10 years in 1.4%. Time from PTLD to retransplant was <1 year in 24.6%, 1–3 years in 37.7%, 3–5 years in 17.4% and 5–10 years in 20.3%. Induction agents were used in 21.7% of first and 47.8% of retransplants. Immunosuppression for first transplant was cyclosporine (CSA) in 55.1%, tacrolimus (TAC) in 27.5% versus CSA in 26.1%, TAC in 66.7% of retransplants. At last follow-up, patient and graft survival are 85.5% and 73.9%, respectively. Most subjects retransplanted after PTLD are <17 years on TAC-based immunosuppression. Patient/graft survival is excellent and retransplantation in PTLD subjects should be considered acceptable.