Risk factors for posttransplant lymphoproliferative disorder (PTLD) in pediatric kidney transplantation: A report of the North American Pediatric Renal Transplant Cooperative Study (NAPRTCS)

Background. Posttransplant lymphoproliferative disorder (PTLD) is an import ant complication of transplantation, The North American Pediatric Renal Tra nsplant Cooperative Study (NAPRTCS) database has documented 56 cases of PTL D, the largest such series to date. Methods, We analyzed the available longitudinal and multicenter data in the NAPRTCS database to evaluate the demographic and therapeutic risk factors and the temporal trends for PTLD in children after renal transplantation. Results. The overall incidence of PTLD was 1.2% of all patients or 298/100, 000 posttransplantation years of follow-up, However, this incidence increas ed from 254/100,000 years between 1987 and 1991 to 395/100,000 years from 1 992 onwards, In the same periods, the time to PTLD decreased from a median of 356 days (range 64-3048) to a median of 190 days (range 42-944). PTLD oc curred with greater frequency in white children (P=0,003) and in cadaver do nor transplants (P=0,019), but there was no significant predilection for ge nder, younger children (0-5 years), or primary diagnosis, No significant di fference was found in the use of anti-T-cell antibodies or in doses of CsA, azathioprine, or prednisone at 1 month, 6 months, and 1 year. Between 1996 and 1997, 69 patients were initiated with tacrolimus, Eight cases of PTLD were identified in these recipients to date (prevalence rate 11.5%), compar ed with 46/4084 (1.1%) where cyclosporine was used (P <0.0001), Conclusions, There is a trend towards increasing incidence and earlier occu rrence of PTLD in the pediatric renal transplant population. White race and cadaver donor sources are risk factors not reported before. Continued moni toring of tacrolimus immunosuppression is important.