Clinical Characteristics of Malignant Lymphomas Developed after Renal Transplantation

Kim, Sung Kwon; Park, Joo Hyun; Shin, Young Shin; Kim, Young Ok; Lee, Seung Hun; Yoon, Sun Ae; Yang, Chul Woo; Kim, Yong Soo; Kim, Suk Young; Bang, Byung Kee

Abstract

PURPOSE: Immunosuppressive agents decrease the immune surveillance mechanisms. As a result, they increase the malignance occurrence rate and decrease the patient survival rate. Especially malignant lymphomas have higher occurrence rate than that in general population. We reviewed clinical characteristics of posttransplant malignant lymphomas.
METHODS
1,450 renal transplant recipients from Kang Nam and Dae Jeon St. Mary's Hospital were reviewed retrospectively. The incidence, time interval from the renal transplantation operation, clinical courses of the 7 malignant lymphomas developed were reviewed.
RESULTS
After renal transplantation, 45 (3.1% incidence rate) malignant tumors developed. Out of them, 7 were malignant lymphomas and showed higher incidence rate than that in general population. Male and female ratio was 4 : 3. Three of them were diagnosed in a year after renal transplantation, other three were diagnosed between 5 to 6 years, and the last one was diagnosed after 16 years. Primary sites were cervical lymph node in three patients, jejunum in two, were diagnosed between 5 to 6 years, and the last one was diagnosed after 16 years. Primary sites were cervical lymph node in three patients, jejunum in two, and each lung and brain. Histologic findings showed 6 B-cell lymphomas and a T-cell lymphoma. Epstein Barr viral infections were confirmed in 3 out of 7 patients using in situ hybridization. Various treatment modalities were used such as reduction of immunosuppressive agents, administration of antiviral drugs, radiation therapy, administration of chemotherapeutic agents, alpha-interferon and intravenous immune globulins. After treatments, 3 reached complete remission, one partial remission, and 3 deaths. The follow up period in case of complete remission after diagnosis was 45~61 months.
CONCLUSION
Malignant lymphomas in renal transplantation recipients treated with immunosuppressive agents are not rare disease. After diagnosis, reduction or cease of immunosuppressive agents and therapy against the tumor were tried, but cease of immunosuppressive agent were frequently refused by the patients. Three patients have survived after treatments.