Post-transplant lymphoproliferative disorder risk and outcomes in renal transplant patients treated with belatacept immunosuppression
IntroductionPost-transplant lymphoproliferative disorder (PTLD) is a rare but life-threatening malignancy that arises in the setting of immunosuppression (IS) after solid organ transplant. IS regimens containing belatacept have been associated with an increased risk of PTLD in Epstein–Barr virus (EB...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2024-01-01
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| Series: | Frontiers in Transplantation |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/frtra.2023.1280993/full |
| _version_ | 1827161160977219584 |
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| author | Jean L. Koff Geeta M. Karadkhele Jeffrey M. Switchenko Manali Rupji Kendra Little Christian P. Larsen |
| author_facet | Jean L. Koff Geeta M. Karadkhele Jeffrey M. Switchenko Manali Rupji Kendra Little Christian P. Larsen |
| author_sort | Jean L. Koff |
| collection | DOAJ |
| description | IntroductionPost-transplant lymphoproliferative disorder (PTLD) is a rare but life-threatening malignancy that arises in the setting of immunosuppression (IS) after solid organ transplant. IS regimens containing belatacept have been associated with an increased risk of PTLD in Epstein–Barr virus (EBV)-seronegative renal transplant recipients, and the use of belatacept is contraindicated in this population. However, the impact of belatacept-based regimens on PTLD risk and outcomes in EBV-seropositive renal transplant recipients is less well characterized.MethodsA case-control study was conducted to investigate how combinatorial IS regimens impact the risk of PTLD and survival outcomes in renal transplant recipients at a large transplant center between 2010 and 2019. In total, 17 cases of PTLD were identified and matched 1:2 to controls without PTLD by age, sex, and transplanted organ(s). We compared baseline clinical characteristics, examined changes in IS regimen, viral loads, and renal function over time, and evaluated time-to-event analyses, including graft rejection and survival.ResultsCases of PTLD largely resembled matched controls in terms of baseline characteristics, although expected differences in EBV serostatus trended toward significance (42.9% of PTLD cases were donor-positive/recipient-negative vs. 8.3% controls, p = 0.063). PTLD cases were not more likely to have received belatacept than controls. Belatacept was not associated with graft rejection or failure, re-transplant, hospitalization, or decreased survival.ConclusionsBelatacept was not associated with an increased risk of PTLD, and was not associated with decreased survival in either PTLD cases or in the entire cohort. Our case-control study supports the concept that belatacept remains a safe and effective option for IS in EBV-seropositive renal transplant patients. |
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| institution | Directory Open Access Journal |
| issn | 2813-2440 |
| language | English |
| last_indexed | 2025-03-21T00:24:31Z |
| publishDate | 2024-01-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Transplantation |
| spelling | doaj.art-042473374dc5455699f6bdc6b4ce0fd72024-08-03T07:34:28ZengFrontiers Media S.A.Frontiers in Transplantation2813-24402024-01-01210.3389/frtra.2023.12809931280993Post-transplant lymphoproliferative disorder risk and outcomes in renal transplant patients treated with belatacept immunosuppressionJean L. Koff0Geeta M. Karadkhele1Jeffrey M. Switchenko2Manali Rupji3Kendra Little4Christian P. Larsen5Department of Hematology and Medical Oncology, Winship Cancer Institute of Emory University, Atlanta, GA, United StatesDepartment of Surgery, Emory University, Atlanta, GA, United StatesBiostatistics Shared Resource, Winship Cancer Institute of Emory University, Atlanta, GA, United StatesBiostatistics Shared Resource, Winship Cancer Institute of Emory University, Atlanta, GA, United StatesOffice of Information Technology, Emory University, Atlanta, GA, United StatesDepartment of Surgery, Emory University, Atlanta, GA, United StatesIntroductionPost-transplant lymphoproliferative disorder (PTLD) is a rare but life-threatening malignancy that arises in the setting of immunosuppression (IS) after solid organ transplant. IS regimens containing belatacept have been associated with an increased risk of PTLD in Epstein–Barr virus (EBV)-seronegative renal transplant recipients, and the use of belatacept is contraindicated in this population. However, the impact of belatacept-based regimens on PTLD risk and outcomes in EBV-seropositive renal transplant recipients is less well characterized.MethodsA case-control study was conducted to investigate how combinatorial IS regimens impact the risk of PTLD and survival outcomes in renal transplant recipients at a large transplant center between 2010 and 2019. In total, 17 cases of PTLD were identified and matched 1:2 to controls without PTLD by age, sex, and transplanted organ(s). We compared baseline clinical characteristics, examined changes in IS regimen, viral loads, and renal function over time, and evaluated time-to-event analyses, including graft rejection and survival.ResultsCases of PTLD largely resembled matched controls in terms of baseline characteristics, although expected differences in EBV serostatus trended toward significance (42.9% of PTLD cases were donor-positive/recipient-negative vs. 8.3% controls, p = 0.063). PTLD cases were not more likely to have received belatacept than controls. Belatacept was not associated with graft rejection or failure, re-transplant, hospitalization, or decreased survival.ConclusionsBelatacept was not associated with an increased risk of PTLD, and was not associated with decreased survival in either PTLD cases or in the entire cohort. Our case-control study supports the concept that belatacept remains a safe and effective option for IS in EBV-seropositive renal transplant patients.https://www.frontiersin.org/articles/10.3389/frtra.2023.1280993/fullpost-transplant lymphoproliferative disorder (PTLD)belataceptrenal transplantimmunosuppression complicationsurvival and prognosisEpstein–Barr virus (EBV) |
| spellingShingle | Jean L. Koff Geeta M. Karadkhele Jeffrey M. Switchenko Manali Rupji Kendra Little Christian P. Larsen Post-transplant lymphoproliferative disorder risk and outcomes in renal transplant patients treated with belatacept immunosuppression Frontiers in Transplantation post-transplant lymphoproliferative disorder (PTLD) belatacept renal transplant immunosuppression complication survival and prognosis Epstein–Barr virus (EBV) |
| title | Post-transplant lymphoproliferative disorder risk and outcomes in renal transplant patients treated with belatacept immunosuppression |
| title_full | Post-transplant lymphoproliferative disorder risk and outcomes in renal transplant patients treated with belatacept immunosuppression |
| title_fullStr | Post-transplant lymphoproliferative disorder risk and outcomes in renal transplant patients treated with belatacept immunosuppression |
| title_full_unstemmed | Post-transplant lymphoproliferative disorder risk and outcomes in renal transplant patients treated with belatacept immunosuppression |
| title_short | Post-transplant lymphoproliferative disorder risk and outcomes in renal transplant patients treated with belatacept immunosuppression |
| title_sort | post transplant lymphoproliferative disorder risk and outcomes in renal transplant patients treated with belatacept immunosuppression |
| topic | post-transplant lymphoproliferative disorder (PTLD) belatacept renal transplant immunosuppression complication survival and prognosis Epstein–Barr virus (EBV) |
| url | https://www.frontiersin.org/articles/10.3389/frtra.2023.1280993/full |
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