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Blood, 16 July 2009, Vol. 114, No. 3, pp. 630-637. Prepublished online as a Blood First Edition Paper on May 14, 2009; DOI 10.1182/blood-2009-02-202507. This Article Full Text (PDF) All Versions of this Article: blood-2009-02-202507v1 114/3/630    most recent Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Rights and Permissions Citing Articles Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by van Leeuwen, M. T. Articles by Vajdic, C. M. Search for Related Content PubMed PubMed Citation Articles by van Leeuwen, M. T. Articles by Vajdic, C. M. Social Bookmarking                   What's this?  Previous Article  |  Next Article  Submitted February 26, 2009 Accepted April 28, 2009 Immunosuppression and other risk factors for early and late non-Hodgkin lymphoma after kidney transplantation Marina T. van Leeuwen, Andrew E. Grulich, Angela C. Webster, Margaret R.E. McCredie, John H. Stewart, Stephen P. McDonald, Janaki Amin, John M. Kaldor, Jeremy R. Chapman, and Claire M. Vajdic* National Centre in HIV Epidemiology and Clinical Research, University of New South Wales, Sydney, NSW, Australia Australia and New Zealand Dialysis and Transplant Registry, Queen Elizabeth Hospital, Adelaide, SA, Australia Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand Disciplines of Medicine and Public Health, University of Adelaide, Adelaide, SA, Australia Centre for Transplant and Renal Research, Millennium Institute, Westmead Hospital, University of Sydney, Sydney, NSW, Australia University of New South Wales Cancer Research Centre, Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, Australia * Corresponding author; email: claire.vajdic{at}unsw.edu.au. Non-Hodgkin lymphoma (NHL) incidence is greatly increased after kidney transplantation. NHL risk was investigated in a nationwide cohort of 8,164 kidney transplant recipients registered on the Australia and New Zealand Dialysis and Transplant Registry. NHL diagnoses were ascertained using linkage with national cancer registry records. Multivariate Poisson regression was used to compute incidence rate ratios (IRR) with 95% confidence intervals (CI) comparing risk by transplant function, and risk factors for early (<2 years) and late (2 years) NHL during the first transplant. NHL occurred in 133 patients. Incidence was strikingly lower after transplant failure and cessation of immunosuppression than during transplant function (IRR 0.25, 95% CI 0.08-0.80, p=0.019). Early NHL (n=27) was associated with Epstein-Barr virus (EBV) seronegativity at transplantation (IRR 4.66, 95% CI 2.10-10.36, p<0.001) and receipt of T-cell-depleting antibodies (IRR 2.39, 95% CI 1.08-5.30, p=0.031). Late NHL (n=79) was associated with increasing year of age (IRR 1.02, 95% CI 1.01-1.04, p=0.006), increasing time since transplantation (p<0.001), and current use of calcineurin inhibitors (IRR 3.13, 95% CI 1.53-6.39, p=0.002). These findings support two mechanisms of lymphomagenesis, one predominantly of primary EBV infection in the context of intense immunosuppression, and another, of dysregulated lymphoid proliferation in a prolonged immunosuppressed state. CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

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