Post‐transplant lymphoproliferative disorders, Epstein‐Barr virus infection, and disease in solid organ transplantation: Guidelines from the American Society of Transplantation Infectious Diseases Community of Practice

Abstract

These updated guidelines from the American Society of Transplantation Infectious Diseases Community of Practice review the diagnosis, management, and prevention of post‐transplant lymphoproliferative disorders (PTLD) and other Epstein‐Barr virus (EBV) syndromes after solid organ transplantation. PTLD are a heterogeneous spectrum of predominantly B‐cell disorders, often extra‐nodal, with complex distinct pathogeneses and variable clinical presentations determined by pathologic subtype. Recent epidemiologic studies report a decrease in early EBV‐positive (+) PTLD and an increase in late EBV‐negative (−) PTLD. Pre‐transplant EBV‐seronegativity and primary EBV infection, often from donor‐transmitted infection, are an important risk factors for EBV syndromes and early EBV + PTLD. Low‐quality evidence supports preemptive prevention strategies for early EBV + PTLD in EBV‐seronegative recipients that involve EBV DNA measurement in peripheral blood using assays requiring further result harmonization, combined with interventions to lower viral load. Reduction in immunosuppression (RIS) is the best validated intervention. WHO pathology classification of a tissue biopsy remains the gold standard for PTLD diagnosis; optimal staging procedures are uncertain. Treatment of CD20+ PTLD with the response‐dependent sequential use of RIS, rituximab, and cytotoxic chemotherapy is recommended. Evidence gaps requiring future research and alternate treatment strategies including immunotherapy are highlighted.

Epstein–Barr Virus-Induced Post-Transplant Lymphoproliferative Disorder of the Central Nervous System Successfully Treated with Chemo-Immunotherapy

“…Treatment of PTLD has been importantly strengthened by Rituximab, a humanized anti-CD20 antibody, which has been widely approved against CD20 positive malignant lymphoma including DLBCL [23]. Although Rituximab has been well established, and is an essential part of the treatment of systemic PTLD, the efficacy of Rituximab for CNS-lymphoma or CNS-PTLD still needs to be debated, because Rituximab has poor CNS penetration due to its large size [24].…”

Extrahepatic malignant neoplasms after liver transplantation: the experience of a single transplant center

“…после ТП. С учетом возможного триггерного воздействия вируса Эпштейна-Барр для ПТЛПЗ, возможно, целесообразен предоперационный скрининг и последующий молекулярногенетический мониторинг этой инфекции, данных для обязательной превентивной профилактики пока недостаточно [24].…”

Epstein-Barr Virus-Associated Post-Transplant Lymphoproliferative Disorders after Hematopoietic Stem Cell Transplantation: Pathogenesis, Risk Factors and Clinical Outcomes

“…PTLD is a common secondary malignancy after SOT, and the most common one is a non-melanoma skin cancer. The incidence is estimated to be 1-33%, with the highest incidence occurring in recipients of multi-visceral and intestinal transplants who receive higher amounts of immunosuppressive agents (7-33%), followed by recipients of lung transplants (3-10%), and heart transplants (2-8%); the lowest incidence occurs in recipients of kidney, pancreatic, or liver transplants (1-2%) [44][45][46][47]. Patients who receive SOT require life-long immunosuppressive agents, therefore, PTLD can occur in the late phase after SOT.…”