1 / 15

POST TRANSPLANT LYMPHOPROLIFERATIVE DISORDER APOLLO HOSPITALS, CHENNAI EXPERIENCE.

POST TRANSPLANT LYMPHOPROLIFERATIVE DISORDER APOLLO HOSPITALS, CHENNAI EXPERIENCE. Dr.M.K.Mani, Dr.K.C.Prakash , Dr.B.Subbarao, Dr.Rajeev A, Dr.Rajagopalan S, Dr.Balasubramanian S, Dr.Abhijit Kishore Korane.

geri
Download Presentation

POST TRANSPLANT LYMPHOPROLIFERATIVE DISORDER APOLLO HOSPITALS, CHENNAI EXPERIENCE.

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. POST TRANSPLANT LYMPHOPROLIFERATIVE DISORDER APOLLO HOSPITALS, CHENNAI EXPERIENCE. Dr.M.K.Mani, Dr.K.C.Prakash, Dr.B.Subbarao, Dr.Rajeev A, Dr.Rajagopalan S, Dr.Balasubramanian S, Dr.Abhijit Kishore Korane.

  2. Apollo hospitals, Chennai:-2179 renal transplants.Live related:- 1980, Cadaver:- 199.

  3. PREDNISOLONE+AZATHIOPRINE (DONAR SPECIFIC TRANSFUSION) 1986-1991 CHANGING PATTERN OF IMMUNOSUPPRESION INTRODUCTION OF CYCLOSPORINE/MMF USE OF ATG/OKT3 IN HIGH RISK/RESISTANT REJECTION PATIENTS. 1992-2004 INTRODUCTION OF TACROLIMUS. USE OF IL-2 BLOCKERS. 2005-2009

  4. Other malignancies diagnosed(7+PTLD):- - Adenocarcinoma of rectum(1), - Carcinoma of uterus(1), - Carcinoma of cervix(1), - Carcinoma of breast(1), - Bronchoalveolar carcinoma(1), - Carcinoma of tongue(1), - Kaposi sarcoma(1).

  5. PTLD our experience:- - We have diagnosed five cases of post transplant lymphoproliferative disorders. - This number may not be representative of actual incidence of the disease.(Patients were lost for follow up).

  6. LaCasce AS. Post-transplant lymphoproliferative disorders. Oncologist 2006; 11: 674–680

  7. Ratio observed/expected malignancies in graft recipients Int J Cancer 60: 183–189, 1995

  8. INCIDENCE OF PTLD • Incidence of post transplant lymphoproliferative disorder is approximately 1%. • The overall incidence of malignancies in Indian transplant recipients is not known. • One centre in India reported 30 malignancies (2.1%) in 26 out of 1400. • Of these post transplant lymphoproliferative disorder accounted for 19 cases (63.3%). • Crit Rev OncolHematol 2005; 56: 71–85. • Arch Intern Med 2003; 163:1997. • IndiaJNRT 2(1) 2009 : 94 – 105.

  9. Risk factors for post-transplant malignancies:- -Viral infections(Epstein-Barr virus, Hepatitis c virus), EBV seronegative patients experienced a 10- 76-fold greater incidence of PTLD when compared with their seropositive counterparts. Transplantation 1999; 68:997–1003

  10. Risk factors for post-transplant malignancies. -Use of the monoclonal antibody OKT3. -Calcineurin inhibitors (tacrolimus). -Cytomegalovirus-seropositive donor, -Younger age at transplantation. Am J Transplant2004; 4: 222–230

  11. PREVENTION OF PTLD. • Patients who are at high risk for the development of PTLD should be identified before transplantation. • EBV infection is a significant risk factor and, EBV serostatus should be determined for all potential transplant recipients. • Aggressive supplemental immunosuppression should be used only in the presence of biopsy-proven acute rejection.

  12. Treatment:- • Withdrawal of the antimetabolite and reduce calcineurin inhibitor dose. • Use of rituximab, ganciclovir, foscarnet. • Chemotherapy(CHOP or cyclophosphamide plus prednisone). • Radiotherapy. • Interferon alfa.

  13. THANK YOU

More Related