CNI withdrawal for post-transplant lymphoproliferative disorders in kidney transplant is an independent risk factor for graft failure and mortality.

CNI withdrawal for post-transplant lymphoproliferative disorders in kidney transplant is an independent risk factor for graft failure and mortality.

Rabot N, Büchler M, Foucher Y, Moreau A, Debiais C, Machet MC, Kessler M, Morelon E, Thierry A, Legendre C, Rivalan J, Kamar N, Dantal J.
PMID : 24964147


Post-transplant lymphoproliferative disorder (PTLD) is not a common complication after transplantation, so prospective studies have been conducted mainly because it is difficult to perform prospective studies. PTLD is mostly a B cell origin and may be associated with EBV. PTLD can occur if the patient's immune system does not respond well to EBV infection. In this study, we investigated the effect of PTLD on the survival of patients and grafts after complete termination of the calcineurin inhibitor (CNI) in kidney transplant recipients.
Patients were selected according to the criteria selected in the study, and follow-up was carried out after diagnosis of PTLD. When the cumulative outcome of 10 years after diagnosis of PTLD was examined, 64.4% of the patients died, The failure rate was 43.9%. Patients diagnosed with PTLD also had worse survival than patients without PTLD. An analysis of the factors affecting these factors showed that patients withdrawing CNI after PTLD had a higher chance of graft failure than patients who continued CNI. As a result of analyzing the hazard ratio, HR - 4.00 and p - value <0.001, CNI withdrawal was the most important factor in the death of the patient. The hazar ratio for the graft loss was also analyzed. As a result, HR-3.07 p-value 0.04 showed that the CNI withdrawal also significantly increased the incidence of graft loss.
This study is an analysis of 104 renal transplant recipients and it is possible to confirm that survival and graft survival of patients with CNI withdrawal were significantly higher than those of patients with renal transplant recipients. Although reduction of immunosuppression (RI) is a first-line treatment in patients with PTLD after kidney transplantation, there is still debate as to whether or not to maintain immunosuppression in PTLD. This study suggests that CNI withdrawal affects the kidney function and ultimately affects the patient's mortality. In other studies, maintaining CNI after PTLD has shown that renal graft survival is improved and CNI is complete He concluded the paper by saying that reduction is safer choice than reduction.

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