Incidence and Outcomes of PTLD: Mayo Clinic Experience with over 6000 Kidney Transplants in a 27-year Period

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E-Poster

Abstract Title

First Name *

Mihai

Last Name *

Dumbrava

Co-author 1

Priscilla Koirala koirala.priscilla@mayo.edu Mayo Clinic Department of Medicine Rochester

Co-author 2

Bradley Johnson Johnson.Bradley@mayo.edu Mayo Clinic Transplant Center Rochester

Co-author 3

Raad Chowdhury rbchowdhury@bwh.harvard.edu Mayo Clinic Department of Medicine Rochester

Co-author 4

Rebecca King king.rebecca@mayo.edu Mayo Clinic Department of Pathology Rochester

Co-author 5

Arushi Khurana Khurana.Arushi@mayo.edu Mayo Clinic Department of Medicine Rochester

Co-author 6

Hatem Amer Amer.Hatem@mayo.edu Mayo Clinic Transplant Center Rochester

Co-author 7

Thomas Habermann Habermann.Thomas@mayo.edu Mayo Clinic Department of Medicine Rochester

Co-author 8

Nelson Leung leung.nelson@mayo.edu Mayo Clinic Department of Medicine Rochester

Co-author 9

Co-author 10

Co-author 11

Co-author 12

Co-author 13

Co-author 14

Co-author 15

Introduction

Methods

Utilizing the transplant database at Mayo Clinic, Rochester, Minnesota, we retrospectively reviewed kidney transplants performed between January 1st, 1995, to December 31st, 2022, for cases of PTLD. Patient variables that were evaluated include demographics, EBV serostatus, and induction therapy. EBV stain positivity and negativity on histology, when available were obtained and reported. Our primary endpoints were occurrence of PTLD after kidney transplantation and graft failure after diagnosis descriptive statistics, univariate analysis, and survival analysis were used to report the data. Incidence rates and 95% Confidence Intervals for the incidence rates were calculated using MedCalc Software Version 22.013.

Results

Over the 27 years, 6047 adult kidney transplants were performed PTLD developed in 107 recipients (Figure 1.). 78/107 (72.9%) cases of PTLD occurred after single kidney transplant and 9/107 (8.4%) occurred after a combined kidney-pancreas or kidney-heart. In this specific cohort the cumulative incidence of 1.7% with 0.210 cases/100 people, not considering cases diagnosed outside of Mayo Clinic after initial transplant and or lost to follow up. 70% of PTLD cases received thymoglobulin, 15% alemtuzumab, and 13% received basiliximab. 53% of the PTLD cases were EBV stain positive and EBV positive PTLD developed earlier as compared to EBV negative (p <0.001). However, graft survival was not different between EBV stain positive versus EBV stain negative (figure 2).

Conclusions

In this retrospective review of one of the largest single center kidney transplant experiences in the PTLD literature, we report 107 cases of PTLD over a 27-year period. The incidence of 1.7% with 0.210 cases/100 people in this cohort may be an underestimate as patients as transplant follow up declines at Mayo Clinic after the first couple of years and diagnosis could have been elsewhere. We also report that EBV stain positive PTLD was diagnosed earlier but did not impact overall graft survival, when compared to EBV stain negative patients. We are currently comparing more granular data to determine the type of induction immunosuppression used and its impact on PTLD and overall patient survival.

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