Identification of non-virologic risk factors for lymphoma after the first year of kidney transplant in adults: A retrospective analysis.

BACKGROUND

Non-virologic risk factors for lymphoma after the first kidney transplant (KT) year or late-onset post-transplant lymphoma (PTL) have been scarcely studied.

METHODS

This secondary study re-analyzed de-identified, non-coded data. Cause-specific Cox regressions analyzed associations between non-virologic risk factors and lymphoma or all-cause mortality among kidney transplant recipients (KTRs) with conditional cancer-free survival one year after KT.

RESULTS

Among 166,256 adult KTRs, factors with the strongest risks for late-onset PTL were recipient age > /= 65 and 50-64 years (HR = 2.38, 95 % CI = 2.25-2.77, HR = 1.77, 95 % CI= 1.58-1.79; respectively) and pretransplant cancer history (HR = 1.46, 95 % CI = 1.21-1.77). Other risk factors for late-onset PTL included alemtuzumab induction, other primary kidney disease, a prior KT, male KTR sex, expanded criteria (ECD) transplant, and acute rejection. Factors associated with a decreased risk of late-onset PTL, albeit with an increased mortality risk, included native diabetic renal disease, pre-transplant dialysis > 2 years, and steroids or proliferation signal inhibitors maintenance immunosuppressant.

CONCLUSION

Non-virologic risk factors including KTRs advanced age or male sex, prior cancer or KT, alemtuzumab induction, ECD transplant, and acute rejection are associated with PTL beyond the first post-KT year.