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INCIDENCE OF POST-TRANSPLANT LYMPHOPROLIFERATIVE DISORDERS IN KlDNEY ALLOGRAFT PATIENTS

Patients receiving either antirejection or porphylactic treatment with OKT3 are reported to have an increased risk of malignancies and in particular lymphoproliferative disorders. This incidence is suggested to be associated with the duration of OKT 3 therapy or the amount of base- line immunosuppression. In order to assess the prevalence of malignancies and lymphoproliferative disorders, 746 patients transplanted between 1/1987 and 12/1991 (with a follow-up of at least 4 years) were analysed. 471 (63%) patients had an initial function (IF) of the graft and 275 (37%) had initial non function (INF). Baseline immunosuppression consisted of CyA (trough level aimed at 100 150 ng/ml, monoclonal RIA) and low dose steroids; patients with INF received in addition 1 @kg azathioprin (CyA trough level at 100 - 120 "g/ml). Biopsy proven steroid resistant rejections were treated in 59 (7.9%) patients with 5 to 7 day courses (10 mg/d). Mean age of patients was (IF) 41 (k12.5) and (INF) 43 (f11.3) years (n.s.). Results: 1. 53 patients (7%) had malignancies; 20 (3%) were of cutaneous origin and 5 (0.7%) were lymphoproliferative disorders. 2. Lymphoproliferative disorders were not observed in patients treated with OKT3; one patient suffered from a basalioma and one patient from a corpus carcinoma (n.s.). 3. Actuarial transplant survival at 5 and 10 years was: IF (and OKT3) - 76%, 73%; (no OKT3) - 86%, 69% ("A); INF (and OKT3) 45%, 45%; (no OKT3) - 69%, 57% (p<O.O5). Conclusions: Patients receiving immunosuppression follow- ing kidney transplantation suffer from an increased risk for malignancies, in particular of cutaneous origin. Nevertheless, the addition of OKT3 for antirejection treatment did not increase the incidence of lymphoproliferative disorders in these patients regardless whether these patients received azathioprin or not. As OKT3 was applicated only for one course at a maximum of 70 mg, we conclude that short courses of OKT3 in combination with a moderate baseline immunosuppression do not increase the incidence of lymphoproliferative disorders.

M. Schult, *V. Kliem, H.J. Schlitt, *R. Brunkhorst, B. Nashan
M. Schult, *V. Kliem, H.J. Schlitt, *R. Brunkhorst, B. Nashan, *Klinik fur Abdominal- und Transplantationschinurgie Klinik fur Nephrologie, Medzinische Hochschnle Hannover, Germany.