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Monoclonal gammopathies in patients after solid organ transplantation. Relationship between posttransplantation immunosuppression and lymphoproliferative disease.
Sečník, Peter ; Franeková, Janka (advisor) ; Racek, Jaroslav (referee) ; Slavík, Luděk (referee)
Introduction: Solid organ transplant (TX) patients have a high risk of post-transplant lymphoproliferative disease (PTLD). One of the candidate methods for identifying an increased risk of developing PTLD are laboratory tests for detection of abnormal synthesis of immunoglobulins - gammopathy (GP). Aims: Main objectives were to determine the frequency of posttransplant GP and PTLD, analyse the impact of GP and PTLD on posttransplant morbidity and mortality, verify the association between GP and PTLD, identify and analyse laboratory markers of early stage PTLD, and use the data to design an effective PTLD diagnostic strategy. Methods: The default cohort consisted of 8034 patients after TX performed at the Institute of Clinical and Experimental Medicine in Prague in the years 1966-2018. For each of the 3 studies performed, a specific subcohort was derived (study 1: 5667 patients, study 2: 96 patients, study 3: 7828 patients). For data evaluation, we used standard epidemiological indicators (incidence risk, incidence rate), Cox regression analysis, Fine and Grey competing risks analysis, and Kaplan-Meier survival analysis. Results: The observed incidence of PTLD was 1.86 (95% CI 1.64-2.08) cases per 1000 person- years with a maximum incidence in the first and fourth-sixth year after TX....
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