Low 5-year cumulative incidence of post-transplant lymphoproliferative disorders after solid organ transplantation in Switzerland

Article Article scientifique Article Low 5-year cumulative incidence of post-transplant lymphoproliferative disorders after solid organ transplantation in Switzerland eng 2018 author Steiner Raphaël 777312 author Kridel Robert author Giostra Emiliano 609263 author Mckee Thomas Alexander 549937 author Achermann Rita author Mueller Nicolas author Manuel Oriol author Dickenmann Michael author Schuurmans Macé M author de Leval Laurence author Fehr Thomas author Tinguely Marianne author Binet Isabelle author Cogliatti Sergio author Haralamvieva Eugenia author Koller Michael 830283 author Dietrich Pierre-Yves 96532 Swiss Transplant Cohort Study w14596 10.4414/smw.2018.14596 29518251 1424-7860 BACKGROUND: Post-transplant lymphoproliferative disorder (PTLD) is a potentially life-threatening complication of transplantation occurring in the setting of immunosuppression and oncogenic viral infections. However, little is known about the cumulative incidence, histological subtypes, risk determinants and outcome of PTLD in solid organ transplant (SOT) recipients in Switzerland. METHODS: This retrospective observational study investigated adult SOT recipients from two sequential cohorts, the pre-SCTS (Swiss Transplant Cohort Study) series, with data collected from January 1986 to April 2008, and the STCS series, with data collected from May 2008 to December 2014 in Switzerland. SOT recipients were cross-referenced with the data of all the patients with a lymphoma diagnosis in each transplant centre and with the data of the Swiss Transplant Cohort Study (STCS) to determine the cumulative incidence of PTLD, pre-therapeutic clinical features, clinical course and outcome. Kaplan-Meier analysis was performed for overall survival after PTLD. RESULTS: We identified 79 cases of PTLD during the study period in the two cohorts: pre-STCS from 1986 to 2008 (n = 62) and STCS from 2008 to 2014 (n = 17). Histological subgroups included: early lesions (pre-STCS n = 2, STCS n = 0); polymorphic PTLD (pre-STCS n = 8, STCS n = 7); monomorphic PTLD (pre-STCS n = 47, STCS n = 10), and Hodgkin's lymphoma (pre-STCS n = 5, STCS n = 0). Median time to PTLD diagnosis was 90 months (range 3-281 months) and 14 months (range 2-59 months) in the pre-STCS and STCS cohorts, respectively. Median follow-up after transplantation was 141 months for the pre-STCS patients and 33 months for the STCS patients. Cumulative incidences of PTLD during the STCS period at 0.5, 1 and 5 years were 0.17% (95% confidence interval 0.07-0.46%), 0.22% (0.09-0.53%) and 0.96% (0.52-1.80%), respectively. For the pre-STCS case series, it was not possible to estimate the incidence rate of PTLD. Survival after PTLD diagnosis was 80% (68-87%) at 1 year and 56% (42-68%) at 5 years for the pre-STCS and STCS cohorts combined. CONCLUSIONS: At 5 years, the cumulative incidence of PTLD, regardless of the organ transplanted, was only 0.96% in the STCS cohort, which is lower than that reported in the literature. Adult Female Humans Immunosuppression/methods Incidence Kidney Transplantation/statistics & numerical data Lymphoma/complications Lymphoproliferative Disorders/diagnosis/epidemiology/etiology Male Postoperative Complications Retrospective Studies Risk Factors Switzerland/epidemiology Time Factors Dewey 616 Dewey 616.07 137 Département de pathologie et immunologie 21F 56 Département de médecine 221 false 27 Immunothérapie des cancers 42 476 Lymphomes MALT et réplication virale 807 Swiss Medical Weekly 148 804edc5a-5139-4087-b9ac-e184afc1b059 Article (Published version) Public SteinerSwissMedWkly2018.pdf 617682 application/pdf CC BY-NC-ND openAccess Faculté de médecine / Section de médecine fondamentale / Département de pathologie et immunologie Faculté de médecine / Section de médecine clinique / Département de médecine

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Faible incidence cumulative de maladie lymphoproliférative post-transplantation à 5 ans en Suisse		2018	544	137
Low 5-year cumulative incidence of post-transplant lymphoproliferative disorders after solid organ transplantation in Switzerland	Swiss Medical Weekly	2018	629	293

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Steiner, Raphaël