POSTTRANSPLANT LYMPHOPROLIFERATIVE DISORDERS

Following kidney transplantation, lymphoproliferative disorders (LD) a re encountered at a frequency of 1%. The onset of these LD is correlat ed with the degree of immunosuppression. The mortality is elevated (> 50%) especially in late forms. Since 1981; we have performed two hundr ed and seventeen kidney transplantations. Tie patients received sequen tial quadruple-drug immunosuppressive therapy: antilymphocyte globulin e (ALG), azathioprine, corticosteroids and cyclosporine. A diagnosis o f LD was established in ten patients, four were of early onset (within twelve months of transplantation) and six late (after five to nine ye ars). Rejection occurred in two patients, one of which was steroid res istant requiring ALG. Three LD arose from the graft hilum, four had a voluminous turner mass with extranodal sites: the graft (1), stomach ( 2), gingiva (1), meninges (1), and bone marrow (1). Histologically the re were eight cases of large-cell B lymphoma, 1 mononucleosis-like LD, and a MALT lymphoma. A search for EBV was positive seven times. Treat ment consisted of decreasing immunosuppressive therapy only (1), combi ned with antiviral treatment (1), or with surgical removal of the graf t (3), and/or chemotherapy (5). Nine patients are still alive, in comp lete remission, graft loss occurred in four cases. Conclusion: in our series, we found a high frequency of LD. Despite 4 LD with a voluminou s tumor mass and unfavorable histological prognosis requiring chemothe rapy, all the LD in our series had a favorable outcome.