Detection of gammopathy by serum protein electrophoresis for predicting and managing therapy of lymphoproliferative disorder in 911 recipients of liver transplants

Monitoring of posttransplantation lymphoproliferative disorder (LPD) Is usu ally based on Imaging, which lacks sensitivity. A prospective study in 911 consecutive recipients of liver transplants was conducted to assess the val ue of gammopathy monitoring by serum protein electrophoresis (SPE) and to c ompare it with conventional follow-up methods. Patients systematically unde rwent SPE testing just before transplantation, at least twice during the fi rst year after transplantation, and once a year thereafter. Patients with L PD underwent SPE testing every month. Immunofixation was done if abnormalit ies were detected by SPE. Gammopathy was observed in 114 patients, 18 of wh om had onset of LPD. In 3 other patients, LPD developed, but no gammopathy was detected before onset of LPD or while LPD was present. Multivariate ana lyses showed gammopathy (relative risk [RR], 65.3), more than one transplan tation (FIR, 7.5), and viral cirrhosis (FIR, 2.8) to be independent prognos tic factors associated with occurrence of LPD. LPD was treated by reducing immunosuppression, with or without chemotherapy, administration of anti-CD2 0 monoclonal antibody, or surgery. The mortality rate was 24% (5 of 21 pati ents). Remission, which occurred in 13 patients, was associated with disapp earance of gammopathy in 10 patients. In 5 patients, normalization of SPE r esults preceded the diagnosis of remission based on imaging, by a mean of 4 months. For diagnosis of LPD remission, the positive and negative predicti ve values of disappearance of gammopathy were 91% and 100%, respectively; a nd gammopathy monitoring was more sensitive than Imaging (100% and 38%, res pectively). Gammopathy monitoring Is an inexpensive, noninvasive, sensitive way to detect LPD and assess the efficacy of treatment. It could be used r outinely in follow-up of recipients of transplants. (C) 2001 by The America n Society of Hematology.