Circulating antibody free light chains and risk of posttransplant lymphoproliferative disorder

E. A. Engels, J. Preiksaitis, A. Zingone, O. Landgren

Research output: Contribution to journalArticlepeer-review

19 Scopus citations


Posttransplant lymphoproliferative disorder (PTLD) is a major complication of solid-organ transplantation. With human immunodeficiency virus infection (an analogous immunosuppressive state), elevated kappa and lambda immunoglobulin free light chains (FLCs) in peripheral blood are associated with increased risk of lymphoma. To assess the role of B-cell dysfunction in PTLD, we measured circulating FLCs among Canadian transplant recipients, including 29 individuals with PTLD and 57 matched transplant recipients who were PTLD-free. Compared with controls, PTLD cases had higher kappa FLCs (median 1.53 vs. 1.07 times upper limit of normal) and lambda FLCs (1.03 vs. 0.68). Using samples obtained on average 3.5 months before PTLD diagnosis, cases were more likely to have polyclonal FLC elevations (i.e. elevated kappa and/or lambda with normal kappa/lambda ratio: odds ratio [OR] 4.2, 95%CI 1.1-15) or monoclonal elevations (elevated kappa and/or lambda with abnormal ratio: OR 3.0, 95%CI 0.5-18). Strong FLC-PTLD associations were also observed at diagnosis/selection. Among recipients with Epstein-Barr virus (EBV) DNA measured in blood, EBV DNAemia was associated with FLC abnormalities (ORs 6.2 and 3.2 for monoclonal and polyclonal elevations). FLC elevations are common in transplant recipients and associated with heightened PTLD risk. FLCs likely reflect B-cell dysfunction, perhaps related to EBV-driven lymphoproliferation. The authors demonstrate that elevated circulating levels of immunoglobulin free light chains are associated with an increased risk of posttransplant lymphoproliferative disorder.

Original languageEnglish (US)
Pages (from-to)1268-1274
Number of pages7
JournalAmerican Journal of Transplantation
Issue number5
StatePublished - May 2012
Externally publishedYes


  • Epstein-Barr virus
  • immunology
  • lymphocyte activation
  • monoclonal gammopathy of undertermined significance
  • posttransplant lymphoproliferative disorder
  • tumor markers

ASJC Scopus subject areas

  • Immunology and Allergy
  • Transplantation
  • Pharmacology (medical)


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