Enigma of Post-Transplant Lymphoproliferative Disorder (PTLD): A Single-Center Experience

Background: Post-Transplant Lympho-proliferative Disorder (PTLD) is a serious complication of immunosuppressive therapy in kidney transplantation. We aim to report the incidence, clinical characteristics and outcomes of patients with this rare entity. Methods: This is an observational retrospective study of cancer patients who received renal transplant, on chronic immunosuppressive therapy and subsequently developed PTLD. Patients who were diagnosed with PTLD between 2015 and 2023, were identified from registry database of our institution. Disease and treatment-related variables were captured from electronic medical records. Results: Thirty-nine patients were diagnosed with post-transplant malignancy, 13 (33.3%) developed PTLD with a mean age of 29.5 years (range: 14-56), with a median follow up of 12 years (range:3-23). The median time between renal transplant and PTLD diagnosis was 8 years (range: 3-22). Immunosuppressive agents include tacrolimus, mycophenolate mofetil and low-dose of steroids. 7 patients (53.8%) were EBV seropositive. Regarding histologic classification, 10 (76.9%) were monophasic, and 3 (23.1%) had classic Hodgkin’s lymphoma. 5 (38.4%) patients had lymph nodes involvement, 4 (30%) bowel, 2 (15.3%) bone marrow and 2 (15.3%) had CNS involvement. All patients had Ann Arbor stage IV but one with stage III. Patients were offered chemotherapy as per protocol (R-CHOP and ABVD), along with reduction of tacrolimus dose and discontinuation of mycophenolate mofetil. Pretreatment mean eGFR was 80.2 mL/min (range: 45-120) before PTLD diagnosis, with mild reduction of mean eGFR to 74.6 mL/min (range: 37-112) at time of last follow up. No patient had renal rejection. 10 patients (76.9%) are in complete metabolic remission with a median survival of 18 months (range: 12-108) while 3 (23.1%) died within 3 months after PTLD diagnosis, 2 died of septic shock and 1 of myocardial infarction. Conclusion: PTLD is a frequent post-renal transplant malignancy, treatment does not impact kidney graft, and disease outcomes are comparable with patient without transplant. Larger studies are warranted to further explore the clinical outcomes of PTLD.