Post-Transplantation Lymphoproliferative Disorder After Kidney Transplantation: Report of a Nationwide French Registry and the Development of a New Prognostic Score

作者：Caillard Sophie^*; Porcher Raphael; Provot Francois; Dantal Jacques; Choquet Sylvain; Durrbach Antoine; Morelon Emmanuel; Moal Valerie; Janbon Benedicte; Alamartine Eric; Noble Claire Pouteil; Morel Delphine; Kamar Nassim; Buchler Matthias; Mamzer Marie France; Peraldi Marie Noelle; Hiesse Christian; Renoult Edith; Toupance Olivier; Rerolle Jean Philippe; Delmas Sylvie; Lang Philippe; Lebranchu Yvon; Heng Anne Elisabeth; Rebibou Jean Michel; Mousson Christiane

来源：Journal of Clinical Oncology, 2013, 31(10): 1302-1309.

DOI：10.1200/JCO.2012.43.2344

Purpose %26lt;br%26gt;Post-transplantation lymphoproliferative disorder (PTLD) is associated with significant mortality in kidney transplant recipients. We conducted a prospective survey of the occurrence of PTLD in a French nationwide population of adult kidney recipients over 10 years. %26lt;br%26gt;Patients and Methods %26lt;br%26gt;A French registry was established to cover a nationwide population of transplant recipients and prospectively enroll all adult kidney recipients who developed PTLD between January 1, 1998, and December 31, 2007. Five hundred patient cases of PTLD were referred to the French registry. The prognostic factors for PTLD were investigated using Kaplan-Meier and Cox analyses. %26lt;br%26gt;Results %26lt;br%26gt;Patients with PTLD had a 5-year survival rate of 53% and 10-year survival rate of 45%. Multivariable analyses revealed that age %26gt; 55 years, serum creatinine level %26gt; 133 mu mol/L, elevated lactate dehydrogenase levels, disseminated lymphoma, brain localization, invasion of serous membranes, monomorphic PTLD, and T-cell PTLD were independent prognostic indicators of poor survival. Considering five variables at diagnosis (age, serum creatinine, lactate dehydrogenase, PTLD localization, and histology), we constructed a prognostic score that classified patients with PTLD as being at low, moderate, high, or very high risk for death. The 10-year survival rate was 85% for low-, 80% for moderate-,56% for high-, and 0% for very high- risk recipients. %26lt;br%26gt;Conclusion %26lt;br%26gt;This nationwide study highlights the prognostic factors for PTLD and enables the development of a new prognostic score. After validation in an independent cohort, the use of this score should allow treatment strategies to be better tailored to individual patients in the future. J Clin Oncol 31:1302-1309.

• 出版日期2013-4-1