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POST TRANSPLANT LYMPHOPROLIFERATIVE DISORDER APOLLO HOSPITALS, CHENNAI EXPERIENCE.

POST TRANSPLANT LYMPHOPROLIFERATIVE DISORDER APOLLO HOSPITALS, CHENNAI EXPERIENCE. Dr.M.K.Mani, Dr.K.C.Prakash , Dr.B.Subbarao, Dr.Rajeev A, Dr.Rajagopalan S, Dr.Balasubramanian S, Dr.Abhijit Kishore Korane.

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POST TRANSPLANT LYMPHOPROLIFERATIVE DISORDER APOLLO HOSPITALS, CHENNAI EXPERIENCE.

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  1. POST TRANSPLANT LYMPHOPROLIFERATIVE DISORDER APOLLO HOSPITALS, CHENNAI EXPERIENCE. Dr.M.K.Mani, Dr.K.C.Prakash, Dr.B.Subbarao, Dr.Rajeev A, Dr.Rajagopalan S, Dr.Balasubramanian S, Dr.Abhijit Kishore Korane.

  2. Apollo hospitals, Chennai:-2179 renal transplants.Live related:- 1980, Cadaver:- 199.

  3. PREDNISOLONE+AZATHIOPRINE (DONAR SPECIFIC TRANSFUSION) 1986-1991 CHANGING PATTERN OF IMMUNOSUPPRESION INTRODUCTION OF CYCLOSPORINE/MMF USE OF ATG/OKT3 IN HIGH RISK/RESISTANT REJECTION PATIENTS. 1992-2004 INTRODUCTION OF TACROLIMUS. USE OF IL-2 BLOCKERS. 2005-2009

  4. Other malignancies diagnosed(7+PTLD):- - Adenocarcinoma of rectum(1), - Carcinoma of uterus(1), - Carcinoma of cervix(1), - Carcinoma of breast(1), - Bronchoalveolar carcinoma(1), - Carcinoma of tongue(1), - Kaposi sarcoma(1).

  5. PTLD our experience:- - We have diagnosed five cases of post transplant lymphoproliferative disorders. - This number may not be representative of actual incidence of the disease.(Patients were lost for follow up).

  6. LaCasce AS. Post-transplant lymphoproliferative disorders. Oncologist 2006; 11: 674–680

  7. Ratio observed/expected malignancies in graft recipients Int J Cancer 60: 183–189, 1995

  8. INCIDENCE OF PTLD • Incidence of post transplant lymphoproliferative disorder is approximately 1%. • The overall incidence of malignancies in Indian transplant recipients is not known. • One centre in India reported 30 malignancies (2.1%) in 26 out of 1400. • Of these post transplant lymphoproliferative disorder accounted for 19 cases (63.3%). • Crit Rev OncolHematol 2005; 56: 71–85. • Arch Intern Med 2003; 163:1997. • IndiaJNRT 2(1) 2009 : 94 – 105.

  9. Risk factors for post-transplant malignancies:- -Viral infections(Epstein-Barr virus, Hepatitis c virus), EBV seronegative patients experienced a 10- 76-fold greater incidence of PTLD when compared with their seropositive counterparts. Transplantation 1999; 68:997–1003

  10. Risk factors for post-transplant malignancies. -Use of the monoclonal antibody OKT3. -Calcineurin inhibitors (tacrolimus). -Cytomegalovirus-seropositive donor, -Younger age at transplantation. Am J Transplant2004; 4: 222–230

  11. PREVENTION OF PTLD. • Patients who are at high risk for the development of PTLD should be identified before transplantation. • EBV infection is a significant risk factor and, EBV serostatus should be determined for all potential transplant recipients. • Aggressive supplemental immunosuppression should be used only in the presence of biopsy-proven acute rejection.

  12. Treatment:- • Withdrawal of the antimetabolite and reduce calcineurin inhibitor dose. • Use of rituximab, ganciclovir, foscarnet. • Chemotherapy(CHOP or cyclophosphamide plus prednisone). • Radiotherapy. • Interferon alfa.

  13. THANK YOU

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