Francis A, et al. - Researchers determined the incidence as well as factors predictive of post-transplant lymphoproliferative disease (PTLD) after kidney transplantation during adulthood and childhood, using the Australian and New Zealand Dialysis and Transplant Registry. The rates of developing lymphoma in adult and paediatric recipients were found to be similar, although a decrease has been noted since the year 2000. Substantially increased risk of PTLD was observed in Epstein–Barr virus (EBV)-negative patients and those with diabetes or induction agent other than anti-CD25 monoclonal antibody.

Methods

• Researchers used the Australian and New Zealand Dialysis and Transplant Registry (1963–2015) in order to calculate the cumulative incidences of PTLD in children (age <20 years) and adults using a competing risk of death model.
• Results were compared with age-matched population-based data using standardized incidence ratios (SIRs).
• Cox proportional hazards regression was used to assess risk factors for PTLD.

Results

• A total of 23 477 patients (92% adult, 60% male) were included.
• Among those, PTLD development was noted in 505, with 50 (10%) occurring in childhood recipients.
• For adult recipients and for childhood recipients, the 25-year cumulative incidence of PTLD was 3.3% [95% confidence interval (CI) 2.9–3.6] and 3.6% (95% CI 2.7–4.8), respectively.
• A 30-fold increased risk of lymphoma was observed in childhood recipients vs the age-matched general population [SIR 29.5 (95% CI 21.9–38.8)], higher than adult recipients [SIR 8.4 (95% CI 7.7–9.2)].
• The following were found to be independently associated with PTLD: Epstein–Barr virus (EBV)-negative recipient serology [adjusted hazard ratio (aHR) 3.33 (95% CI 2.21–5.01), P < 0.001], year of transplantation [aHR 0.93 for each year after the year 2000 (95% CI 0.88–0.99), P=0.02], induction with an agent other than anti-CD25 monoclonal antibody [aHR 2.07 (95% CI 1.16–3.70), P=0.01] and having diabetes [aHR 3.49 (95% CI 2.26–5.38), P < 0.001].