Johnson SR et al. (2006) Retransplantation after post-transplant lymphoproliferative disorders: an OPTN/UNOS database analysis. Am J Transplant 6: 2743–2749

Post-transplantation lymphoproliferative disorder (PTLD), a serious complication of immunosuppression, often leads to graft loss or death. PTLD survivors can be retransplanted, but are at risk of developing recurrent PTLD. Johnson et al. reviewed the Organ Procurement and Transplant Network/United Network for Organ Sharing database to investigate the safety and efficacy of retransplantation following PTLD.

Data from 69 transplant recipients (27 kidney, 22 liver, 9 lung, 6 heart, 4 intestine and 1 pancreas) who had developed PTLD and undergone retransplantation between October 1987 and June 2004 were analyzed. At time of first transplant, 44 (63.8%) patients were aged <17 years. Twenty-three (33%) individuals had developed PTLD within 1 year, and 38 (55.1%) within 3 years, of first transplant. Immunosuppressive strategies reflected national trends over time, with induction immunosuppression more common in retransplants than in first transplants (33 patients vs 15 patients); in terms of maintenance immunosuppression, a shift from ciclosporin-based to tacrolimus-based regimens was seen. Acute rejection and chronic rejection were the most common causes of graft loss after first transplant. After a mean period of 784 ± 82 days following retransplantation, 59 (85.6%) patients were still alive, 51 (73.9%) patients had functioning second allografts and no patient had developed recurrent PTLD.

The authors state that the timing of retransplantation is important—most of the patients investigated had been in remission from PTLD for ≥1 year before receiving a second graft—but that each case should be assessed individually.