Small intestinal involvement by lymphoproliferative disorders post-renal transplantation: A report from the post-transplant lymphoproliferative disorder international survey

Baqiyatallah Research Center for Gastroenterology and Liver Diseases, Baqiyatallah University of Medical Sciences, Tehran, Iran.
Saudi journal of kidney diseases and transplantation: an official publication of the Saudi Center for Organ Transplantation, Saudi Arabia 01/2013; 24(3):487-94. DOI: 10.4103/1319-2442.111017
Source: PubMed


In this study, data on post-renal transplant lymphoproliferative disorders (PTLD) collected from the existing literature were pooled and analyzed to compare the characteristics, predictors and prognosis of small intestinal PTLDs. We performed a comprehensive search for the available data by Pubmed and Google scholar search engines for reports on this subject. Data from 18 previously published studies, comprising 120 renal allograft recipients, were included in the analysis. Renal transplant recipients with intestinal PTLD were significantly less likely to have Hogkin's and Hogkin's-like lesions (P = 0.044) and to be younger at the time of transplan-tation (P = 0.07). Except for Hodgkin's-like lesions, histopathological evaluations elsewhere were comparable between the group with PTLD in the small intestine and age- and sex-matched renal transplant recipients with PTLD in other sites. The overall mortality was relatively higher in the control group (P = 0.09). When death only due to PTLD was used as the outcome, a trend toward better outcome was seen for the intestinal PTLD group compared with the other localizations (P = 0.1). The 1- and 5-year survival rates for intestinal PTLD patients were 57% and 37%, respectively, compared with 54% and 21%, respectively, for the control group. According to our findings based on analysis of international data, renal transplant patients with small intestinal PTLD are more likely to be of younger age but less frequently represent Hodgkin's and Hodgkin's-like lesions. They also have better patient survival compared with transplant recipients with PTLD in other locations. Further multi-center prospective studies are needed to confirm our results.

1 Read
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Knowledge of the significance of post-transplant lymphoproliferative disorders (PTLD) that occur "very late" or more 10 years after renal transplantation is limited. thus, we analysed and compared characteristics and prognosis of the disease in renal transplant patients with very late onset PTLD vs. early- and late-onset PTLD. Retrospective study of data obtained from comprehensive search of medical literature We searched for available data using the Pubmed and Google scholar search engines for reports of lymphoproliferative disorders occurring in renal transplant patients by disease presentation time. We analyzed data from 27 studies that included 303 patients with lymphoproliferative disorders after renal transplantation. Renal graft recipients with very late onset PTLD were significantly less likely to be under mycophenolate mofetil (MMF)- and/or tacrolimus (FK-506) (vs. azathioprine) -based immunosuppression (P=.035) and less likely to have a history of antibody induction immunosuppression (P<.001). Compared to "early onset" disease, "very late" onset PTLD is more likely to develop in older patients (P=.032). Survival analysis did not show any difference in outcome (P=.5). no organ involvement priority was found for this patient group (P>.1 for all). Older renal transplant patients are at increased risk for development of very late onset PTLD, and should be strictly followed. further multi-institutional prospective studies are needed to confirm our results.
    Hematology/ Oncology and Stem Cell Therapy 04/2011; 4(2):73-80. DOI:10.5144/1658-3876.2011.73
  • [Show abstract] [Hide abstract]
    ABSTRACT: The last 5 years have seen an expansion of knowledge about the gastrointestinal diseases that may present in haematopoietic stem cell transplant (HSCT) patients and also about new gastrointestinal diseases in this patient population. This article summarizes the recent opinions and findings regarding gastrointestinal graft-versus-host disease, and viral and other opportunistic gastrointestinal infections that can develop in HSCT patients. This article also discusses the more newly described entities of mycophenolate-mofetil-related gastrointestinal injury and cord colitis syndrome. This review emphasizes the need for comprehensive clinical information when assessing gastrointestinal endoscopic biopsies from HSCT patients. It is crucial that both clinicians and histopathologists are aware of several specific but rare gastrointestinal diseases that may develop in these patients, because several of these diseases have specific treatments.
    Current opinion in supportive and palliative care 04/2014; 8(2). DOI:10.1097/SPC.0000000000000051 · 1.66 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The assessment of gastrointestinal (GI) specimens from transplant patients is complicated by the wide range of, potentially rare, pathologies that may be found in this clinical setting. Acute GI graft versus host disease (GvHD) is characterised by epithelial cell apoptosis, although there is increasing recognition that acute and/or chronic inflammation may also be present. By contrast, there are thus far no histological features known to be specific to chronic GI GvHD. Mycophenolate mofetil colitis may mimic both GvHD and inflammatory bowel disease, whereas both CMV and adenovirus infections can cause gland apoptosis. Post-transplant lymphoproliferative disorder should be considered if a Crohn's like histological picture is seen, and granulomas in biopsies from umbilical cord blood recipients should raise a suspicion of cord colitis syndrome. Finally, the GI tract may be involved directly or indirectly by the disease that originally required haematopoietic stem cell or liver transplantation. This article is protected by copyright. All rights reserved.
    Histopathology 09/2014; 66(4). DOI:10.1111/his.12542 · 3.45 Impact Factor