Identifying the patient at risk for post‐transplant lymphoproliferative disorder

Abstract

Post-transplant lymphoproliferative disorders (PTLD) are a recognized complication of the immunosuppression required to prevent allograft rejection, occurring in 1-20% of recipients of solid organ transplants. Several factors greatly increase the risk of developing PTLD early post-transplant in any individual recipient. Epstein-Barr virus (EBV) infection is critical in the pathogenesis of the majority of these cases. Pre-transplant EBV seronegativity increases the incidence of PTLD 10- to 75-fold over that of EBV-seropositive recipients. Other risk factors include very young recipient age, cytomegalovirus infection or mismatching (donor positive-recipient negative), aggressive immunosuppression with conventional biologic agents, and the type of organ transplanted. In contrast, the risk of developing PTLD late in the post-transplant course does not appear to be influenced by the type of immunosuppressive agents employed, but rather by the duration of any immunosuppression. The role of EBV in late PTLD is also less certain, as a greater proportion of lesions are not associated with evidence of EBV infection. As the understanding of these risk factors has expanded, opportunities exist to target those populations at highest risk for the development of PTLD for aggressive monitoring and pre-emptive or prophylactic therapy. It is hoped that implementation of such strategies will render early PTLD a preventable complication of transplantation.

Lymphomas After Solid Organ Transplantation: A Collaborative Transplant Study Report

“…By contrast, induction with anti-IL2 receptor antibodies was not associated with increased lymphoma incidence. OKT3 may promote the development of lymphoma by suppressing cytotoxic effector cells and also by promoting proliferation of EBV-infected B cells through cytokine release (36). The cumulative load of immunosuppression appears to be a primary determinant of the incidence of lymphoma early after transplantation.…”

Enfermedad linfoproliferativa postrasplante de órgano sólido

“…Se ha informado su ocurrencia en 13 % a 33 % de los receptores de trasplante multivisceral; 7 % a 11 % de los de intestino; 9,4 % de los de corazón-pulmón; 1,8 % a 7,9 % de los de pulmón; 3,4 % de los de corazón; 2,2 % de los de hígado y 1 % de los de riñón (3). Entre las hipótesis propuestas para estas diferencias están las variaciones en los protocolos de inmunosupresión y las diferencias intrínsecas entre los tejidos que pueden también contribuir a la patogénesis de la enfermedad.…”

“…La mayoría se asocian con infección por el virus de EpsteinBarr (VEB) y parecen representar proliferaciones de células B o más raramente de células T que ocurren en el contexto de una vigilancia inmune disminuida secundaria al uso de drogas inmunosupresoras para prevenir el rechazo (2). La ELPT ocurre en 1 % a 20 % de los pacientes trasplantados y su incidencia depende del tipo de órgano y de factores adicionales (3). Esta revisión presenta una actualización sobre la ELPT en pacientes con trasplante de órgano sólido con én-fasis en el trasplante renal.…”

Post-transplantation lymphoproliferative disorder in a child with multivisceral transplant

“…Most cases are associated with B-lymphocyte proliferation and EBV infection [1]. PTLD usually occurs within 1 year of transplantation and is most prevalent in multivisceral transplant recipients [2]. Although intra-abdominal organs are most frequently affected, particularly the liver and GI tract, sites of involvement vary with the type of allograft [2].…”

“…PTLD usually occurs within 1 year of transplantation and is most prevalent in multivisceral transplant recipients [2]. Although intra-abdominal organs are most frequently affected, particularly the liver and GI tract, sites of involvement vary with the type of allograft [2]. Imaging features depend on the organs involved, and tissue sampling is required for diagnosis and classification.…”