Post Transplant Lymphoproliferative Disorder (PTLD)- Test your knowledge!
This month in the American Journal of Kidney Diseases, Kasiske et al performed a retrospective cohort study comparing the incidence of posttransplant lymphoproliferative disorder (PTLD) using 2 separate data registries. They found a striking 2-fold higher incidence rate of PTLD when using Medicare claims data versus OPTN data. Risk factors for patient and graft survival are compared and discussed. In the editorial to this article, Dr. Hricik discusses the importance of this study.
The following questions are intended to highlight the key points of the article:
1. In the OPTN database, which of the following risk factors were found to increase the risk for PTLD?
a. Use of anti-lymphocyte globulin
b. Recipient EBV seronegative status
c. Donor EBV seropositive status
d. African American ethnicity
e. Tacrolimus use
f. Recipient CMV seronegative status
g. Age group 35-65 years
h. IL-2RA use
2. Which of the above risk factors results in the highest relative risk for PTLD?
3. Which of the following is a possible explanation for the higher incidence of PTLD documented by Medicare claims as compared to the OPTN database?
a. OPTN under-reporting
b. Medicare over-reporting
c. Cases of PTLD diagnosed in the community were not reported to the OPTN
d. All of the above
4. The Collaborative Study Group revealed a higher incidence of PTLD than the current study. This is most likely due to:
a. Higher incidence of PTLD in European nations
b. Greater use of anti-lymphocyte globulin in the international community
c. Longer follow up in the Collaborative Study Group
5. When are the majority of PTLD cases diagnosed?
a. Within the first year after transplantation
b. Within the second year after transplantation
c. After the third year post transplantation.
6. Which of the following statements regarding graft survival after PTLD diagnosis is incorrect?
a. The high graft failure rate was largely attributable to the high mortality rate of patients with PTLD
b. The graft failure rate for patients with PTLD was higher than for matched controls
c. Death censored graft failure was the same for patients with PTLD as compared to matched controls
d. The estimated risk of all-cause graft failure was slightly lower for patients with PTLD identified from only Medicare claims than for patients identified from only OPTN data or both sources, although the differences did not reach statistical significance.
7. Which of the following disorders would be considered a diagnosis of “PTLD?” More than one answer may be correct.
a. Mononucleosis-like illness resulting from a benign polyclonal expansion of B cells
b. Malignant monoclonal B cell lymphoma within the first year post transplant
c. Malignant T cell lymphoma 5 years after transplantation
d. Non-Hodgkin’s B cell lymphoma not associated with EBV replication
Answers to this quiz can be found here.
Post by Vinay Nair
eAJKD Board Member
Very cool blog feature.
Is plasma cell dyscrasia following a kidney transplant considered PTLD? or that is considered as a different entity?
Also, is there any data on use of cam path and risk of PTLD?
Great questions. Plasma cell dyscrasia is also considered a rare subtype of PTLD. In an analysis by Kirk (see reference below), Alemtuzumab (Campath) was not found to be associated with PTLD.
Kirk AD, Cherikh WS, Ring M, et al. Dissociation of
depletional induction and posttransplant lymphoproliferative disease
in kidney recipients treated with alemtuzumab. Am J Transplant.