Incidence of post-transplantation lymphoproliferative disease in Andalusia (1990-2009).

BACKGROUND

Post-transplantation lymphoproliferative disease (PTLD) is a severe complication of renal transplantation (RT) but information about its incidence and predisposing factors is diverse, varying according to geographic area and study period.

METHODS

We analyzed the incidence of PTLD after all RT performed at adult transplantation centers in Andalusia from January 1, 1990 to December 31, 2009, recorded in the Andalusian Transplant Co-ordination Information System (SICATA) regional computerized database (n = 5577). We calculated the risk of PTLD using the Kaplan-Meier curve, censoring for organ failure and incidence rate per patient-year of exposure. Log-rank comparisons were made by center (n = 5), decade (1990-1999 vs 2000-2009), age group, recipient gender, hepatitis C virus (HCV) serology, transplantation number, and duration of pre-RT replacement therapy (per quartiles).

RESULTS

We identified 60 cases of PTLD. The pre-RT treatment time was 48.2 ± 60 months; 11.7% were retransplantations, and 10.4% had a positive HCV serology. The median post-RT time before diagnosis of PTLD was 5.98 years. At the time of the database analysis, only 11 patients (18%) were alive with a functioning transplant; 10% had returned to dialysis and 72% had died. The actuarial incidence of PTLD at 1, 5, 10, and 20 years post-RT was 0.2%, 0.5%, 1.6%, and 2.9%, respectively; the exposure rate was 14.71 PTLD/10,000 patient-years (95% confidence interval [CI], 12.3-17.1). Although the incidence tended to be higher in 1990-1999 than 2000-2009 (16.8 vs 12.1 cases/10,000 patient-years), in the actuarial study the difference was far from significant (at 7.5 years, 1.2 vs 0.8%; P = .4). Nor were there significant differences in the curves of incidence per RT center (1%-1.2% of patients) or recipient characteristics.

CONCLUSIONS

The cumulative incidence of PTLD in Andalusia in patients with a functioning kidney transplant during 1990-2009 was 2.9% at 20 years. There was no significant variation between the RT centers or over time. No associated factors were identified among the basic recipient variables studied.