To investigate the clinical characteristics and outcomes of post-transplant lymphoproliferative disorder (PTLD) in adult kidney transplant recipients.

A retrospective analysis was conducted on the clinical data of 41 kidney transplant recipients diagnosed with PTLD at the First Affiliated Hospital, Zhejiang University School of Medicine from September 1, 2013, to August 30, 2024. Intergroup comparisons of normally distributed measurement data were performed using group t-test; non-normally distributed measurement data were compared using the Kruskal-Wallis test; categorical data were compared using the chi-square test or the Fisher′s exact test. Kaplan-Meier survival curves were plotted with recipient death as the endpoint, and intergroup survival rates were compared using the log-rank test. Cox proportional hazards model was used to analyze risk factors affecting recipient survival. Cutoff values for continuous variables were determined by receiver operating characteristic curves. A P-value <0.05 was considered statistically significant.

As of November 30, 2024, 14 recipients had died, and 27 were alive. Significant differences were observed between the survival and death groups in the time from transplantation to PTLD diagnosis and the situation of presence of multi-organ involvement (all P <0.05). At the time of PTLD diagnosis, serum creatinine levels were 111.0 (86.0-177.0) μmol/L in the survival group and 142.5 (123.8-171.8) μmol/L in the death group, with a statistically significant difference (H=4.694, P<0.05). The average overall survival period after PTLD diagnosis in the 41 kidney transplant recipients was (83±11) months (1-132 months). Recipients with a time from transplantation to PTLD diagnosis >1 year had a lower survival rate than those with≤1 year (χ²=4.044, P<0.05); recipients with multi-organ involvement had a lower survival rate than those without (χ²=4.368, P<0.05). Multivariate Cox proportional hazards regression analysis showed that a time from transplantation to PTLD diagnosis>1 year (HR=0.108, 95%CI: 0.013-0.992), lactate dehydrogenase>285 U/L (HR=0.171, 95%CI: 0.034-0.874), and multi-organ involvement (HR=0.182, 95%CI: 0.039-0.856) were independent risk factors affecting the survival of PTLD recipients (all P<0.05). There was no significant difference in survival rates between recipients receiving R-sequential therapy and those receiving R-CHOP or other R-containing chemotherapy regimens (χ²=0.001, P>0.05); recipients who achieved lymphoma remission after treatment had a higher survival rate than those who did not (χ²=15.859, P<0.05). Epstein-Barr virus (EBV) and CMV infections were more common in the early-onset PTLD group (all P<0.05).

Adult kidney transplant recipients who diagnosed with PTLD have a poor prognosis, EBV and CMV infections are more common in early-onset PTLD. Time of diagnosis >1 year post-transplantation, multi-organ involvement, and elevated lactate dehydrogenase levels are risk factors for survival.