ESPN 51th Annual Meeting

ESPN 2018


 
POST TRANSPLANT LYMPHOPROLIFERATRIVE DISORDERS: ANALYSIS OF THE FRENCH NATIONWIDE PEDIATRIC RENAL RECIPIENTS COHORT OVER THE 2000-2016 PERIOD
GOLEY MELANIE 1 NAGOT NICOLAS 1 BAUDOUIN VERONIQUE 7 RANCHIN BRUNO 2 BOYER OLIVIA 3 ROUSSEY-KESSLER GWENAELLE 5 GARAIX FLORENTINE 4 VRILLON ISABELLE 6 CLOAREC SYLVIE 8 ULINSKI TIM 9 BROCHARD KARINE 10 LAHOCHE ANNIE 1 TAQUE SOPHIE 12 ZALOSZYC ARIANE 13 TENENBAUM JULIE 1 DUNAND OLIVIER 14 PIETREMENT CHRISTINE 15 BERARD ETIENNE 17 HARAMBAT JEROME 16 DESHAYES AURELIE 18 MACHER MARIE ALICE 18 MORIN DENIS 1 FILA MARC 1

1- CHU ARNAUD DE VILLENEUVE - MONTPELLIER - FRANCE
2- CHU LYON HFME - LYON -FRANCE
3- CHU NECKER ENFANTS MALADES - APHP - PARIS - FRANCE
4- CHU MARSEILLE HOPITALK DE LA TIMONE - APHM - MARSEILLE - FRANCE
5- CHU NANTES HOPITAL MERE ENFANT PEDIATRIE - NANTES - FRANCE
6- CHRU NANCY HOPITAL BRABOIS - NANCY - FRANCE
7- CHU ROBERT DEBRE - APHP - PARIS - FRANCE
8- CHRU CLOCHEVILLE - TOURS - FRANCE
9- CHU ARMAND TROUSSEAU - APHP - PARIS - FRANCE
10- CHU TOULOUSE HOPITAL DES ENFANTS - TOULOUSE - FRANCE
11- CHRU LILLE HOPITAL JEANNE DE FLANDRES - LILLE - FRANCE
12- CHU RENNES HOPITAL PONTCHAILLOUX - RENNES - FRANCE
13- CHRU STRASBOURG HOPITAL DE HAUTEPIERRE - STRASBOURG - FRANCE
14- CHU LA REUNION HOPITAL FELIX GUYON - ST DENIS - FRANCE
15- CHRU REIMS AMERICAN MEMORIAL HOSPITAL - REIMS - FRANCE
16- CHU BORDEAUX HOPITAL PELLEGRIN - BORDEAUX - FRANCE
17- CHU NICE HOPITAL LARCHET - NICE - FRANCE
18- AGENCE DE LA BIOMEDECINE - LA PLAINE ST DENIS - FRANCE
 
Introduction:

Post transplant lymphoproliferative disorder (PTLD) is the most frequent malignant complication in pediatric renal transplantation. Data from registries provided some informations about incidence and mortality rates but only scarce data are available about the therapeutic management, outcome and risk factors for the occurrence of PTLD in pediatric recipients. The aims of this study were: -Describe PTLD incidence, clinical and histopathological features, therapeutic management and the patient and renal graft outcome in pediatric renal transplanted patients in France over the 2000-2016 period. -Identify risk factors for PTLD occurrence in pediatric renal recipients.

Material and methods:

Using the french nationwide registry for renal transplantation CRISTAL, any pediatric patient who received a renal transplantation between year 2000 and 2016 was included and PTLD cases identified. To improve completeness, data were also collected from the 17 french pediatric nephrology transplantation centers. The data collected for each patient were age at transplantation, sex, initial nephropathy, HLA matching, EBV and CMV serostatus and immunosuppressive regimen. Renal assessment was performed at 1 year and at last follow up. Mutivariate analysis (Cox model) was performed to highlight risk factors for PTLD occurrence.

Results:

Over the 2000-2016 period, PTLD occured in 40 out of 1285 renal transplanted patients. The median time to PTLD onset after transplantation was 23 months [3-192]. The cumulative incidence of PTLD at 5 years after transplantation was 2.45% with an increased risk in the first year after transplantation. Median patient follow up after PTLD occurrence was 3 years [1-12.9]. Over this period, PTLD occurrence did not significantly affect graft survival (HR 0.495 [95% CI 0.153-1.16], p0.16) and patient survival (HR 2 [95% IC 0.323-6.08]; p0.34). Independant risk factors for PTLD occurrence are young age at transplantation, EBV serostatus mismatch (R-/D+), second renal transplantation and the use of tacrolimus.

Conclusions:

The definition of reliable risk factors is essential to identify patients at risk of PTLD and to personnalize immunosuppressive regimen. Our results suggest to discuss the use of tacrolimus in young recipient with EBV mismatch serostatus (R-/D+).