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Post-transplant lymphoproliferative risk in pancreas recipients

Post-transplant lymphoproliferative in pancreas recipients has a worse prognosis than in other transplant recipients, and these immunosuppressed patients, who often face multiple transplants, may be at greater risk, reports the latest Transplantation.

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Post-transplant lymphoproliferative disorder is a rare, serious complication of transplantation.

The characteristics and associations of this disease in pancreas recipients have not been extensively studied.

Dr Steven Paraskevas and colleagues performed 787 pancreas and 569 kidney-pancreas transplants from 1988 to 2002 at their institution.

The research team reported that 18 pancreas recipients developed polymorphic posttransplant lymphoproliferative disorder or malignant lymphoma.

Data on clinical course, organ involvement, molecular characteristics was compiled from the institutional transplant database

Cytomegalovirus infection may play an antecedent role
Transplantation

The researchers also compiled data on and association with immunosuppression and recent cytomegalovirus infection.

Patient survival was compared to recipients of liver and kidney transplants at the same center by using Kaplan-Meier analysis.

The researchers found that the 5-year cumulative incidence of posttransplant lymphoproliferative in simultaneous pancreas-kidney recipients was 3%.

The 5-year cumulative incidence of post-transplant lymphoproliferative in pancreas after kidney recipients was 1.2%.

In pancreas transplant alone recipients, the 5-year cumulative incidence of the disease was 1%.

The team noticed a higher, but not significant, cumulative incidence in the more recent era since 1995.

Post-transplant lymphoproliferative in pancreas recipients carried a worse prognosis than in liver or kidney for recipients B-cell.

The researchers also observed that Post-transplant lymphoproliferative had a worse prognosis with early-onset, and Epstein Barr virus-positive lesions.

Posttransplant lymphoproliferative was more aggressive in pancreas recipients, with a higher stage at presentation and a trend to more bone marrow involvement.

The research team noted a tendency toward association with recent cytomegalovirus infection.

Since 1995, the team observed that post-transplant lymphoproliferative recipients have had a lower exposure to antilymphocyte preparations.

Dr Paraskevas' team concludes, “Posttransplant lymphoproliferative in pancreas recipients remains a rare but aggressive disease, and carries a worse prognosis in comparison to other transplant recipients.”

“These heavily immunosuppressed patients, who often face multiple transplants, may be at greater risk; cytomegalovirus infection may play an antecedent role.”

Transpl 2005: 80(5) 613-22
22 September 2005

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