Recurrent and de novo disease in kidney, heart, lung, pancreas and intestinal transplants

Purpose of review To update recent developments on recurrent and de novo disease. Recent findings Both recurrent and de novo disease can be the cause of graft loss. Data interpretation is difficult due to differing definitions of recurrence and sometimes a lack of accurate diagnosis of the primary disease, particularly in renal transplantation. Small study size and the duration of follow-up limit the accuracy of data. The sporadic variant of focal segmental glomerulosclerosis recurs early post-transplantation, leading to an increased risk of graft loss. Advances in cardiac transplantation for amyloidosis are promising. Recurrent lymphangioleiomyomatosis in lung transplants occurs by metastasis of benign lymphangioleiomyomatosis cell clusters. Lung transplantation for bronchioalveolar carcinoma and stage 1 bronchogenic carcinoma has 5-year survival rates comparable to the overall International Society for Heart and Lung Transplantation registry figures. Recurrent diabetes mellitus occurs in 4–5% of pancreatic transplant recipients a mean of 5.7 years post-transplantation. Histological evidence of recurrent Crohn's disease occurs without, and does not herald, clinical recurrence. Intestinal transplantation for desmoid tumors has comparable results to non-neoplastic indications for transplantation. Summary Despite progress, controlled multicenter studies are required using a unified definition for recurrence and de novo disease to fully understand the true impact of these entities.