Post-transplant lymphoproliferative disorder after adult-to-adult living donor liver transplant: case series and review of literature.
ABSTRACT Post-transplant lymphoproliferative disorder (PTLD) is a serious complication of solid organ transplant. Although living donor liver transplant (LDLT) has been increasingly performed, PTLD after LDLT has not been well investigated. We aimed to determine the clinical characteristics of PTLD after LDLT. We investigated 323 consecutive patients undergoing adult-to-adult LDLT and identified three patients who developed biopsy-proven PTLD. All of them were seropositive for Epstein-Barr virus (EBV) and had hepatitis C virus-related cirrhosis at transplant. All three patients developed late-onset and monomorphic PTLD, including one diffuse large B-cell lymphoma and two Burkitt lymphomas with c-myc rearrangement. Two of them were EBV negative. The initial therapy included chemotherapy, rituximab, and immunosuppression withdrawal. One patient died of sepsis during treatment and two patients achieved complete responses. We showed a relatively low incidence and distinct clinicopathological features of PTLD after adult-to-adult LDLT, which might reflect the unique nature of LDLT.
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ABSTRACT: Chan TSY, Hwang Y-Y, Gill H, Au W-Y, Leung AYH, Tse E, Chim C-S, Loong F, Kwong Y-L. Post-transplant lymphoproliferative diseases in Asian solid organ transplant recipients: late onset and favorable response to treatment. Abstract: Nineteen consecutive patients with post-transplant lymphoproliferative disorders (PTLD) in an Asian population were reviewed. The histopathologic diagnoses were monomorphic (CD20-positive diffuse large B-cell lymphoma, n = 14); plasmacytic (n = 1); Burkitt-like (n = 1); natural killer cell lymphoma (n = 1); lymphomatoid papulosis (n = 1); and classical Hodgkin lymphoma (n = 1). Early-onset (<one yr post-transplantation) PTLD constituted only 10% of cases, and all were Epstein-Barr virus (EBV) positive. EBV-negative cases (n = 6) developed at a median of 92 (19-170) months, whereas EBV-positive cases occurred later at 128 (7-230) months. With reduction of immunosuppression followed by local therapy, treatment with the anti-CD20 antibody rituximab with or without combination chemotherapy, complete remission was achieved in 17/19 (90%) of cases. Lactate dehydrogenase level, stage, extranodal involvement, EBV status, and International Prognostic Index had no impact on treatment outcome. EBV-positive PTLD occurred much later in Asian patients. Treatment results of PTLD were favorable.Clinical Transplantation 02/2012; 26(5):679-83. · 1.49 Impact Factor
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ABSTRACT: BACKGROUND: Organ transplant recipients have an increased incidence of malignancy. Race differences in a variety of malignancies are observed among the general population, but de novo malignancies after adult-to-adult living-donor liver transplantation (LDLT) have not been compared with those from a Japanese population-based study. METHODS: The subjects were 360 adult LDLT recipients who survived more than 1 year after transplantation. An annual medical checkup and screening examinations were performed as follows: abdominal computed tomography or magnetic resonance imaging, upper gastrointestinal endoscopy, and total colonoscopy and immunochemical fecal occult blood test every 1 to 2 years. Complete blood count, liver function tests, and several tumor markers were checked every 1 to 3 months after LDLT. RESULTS: Mean follow-up period was 7.5±3.4 years. During the follow-up period, 27 de novo malignancies were diagnosed in 26 recipients. Colorectal cancer was the most commonly detected malignancy. The overall mortality of the recipients with de novo malignancies was similar to the findings of the Japanese general population-based study (standardized mortality ratio=0.9). Overall, the incidence of cancer was significantly higher in transplant recipients than in the Japanese general population (standardized incidence ratio=1.8). The 5-year estimated survival rate of recipients with de novo malignancies was 81% and those of recipients without malignancies was 93% (P<0.0001). CONCLUSIONS: Colorectal malignancies predominated in Japanese liver transplant recipients. Although de novo malignancies correlated with a poor prognosis, the standardized mortality ratio was 0.9 compared with that of subjects of a Japanese population-based study.Transplantation 04/2013; · 3.78 Impact Factor
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ABSTRACT: Die Transplantation von soliden Organen und Knochenmark erfordert zur Verhinderung einer Abstoßungsreaktion eine medikamentöse Immunsuppression, die dosis- und medikamentenabhängig die Entstehung von Epstein-Barr-Virus- (EBV-)assoziierten Posttransplantationslymphoproliferationen („post-transplant lymphoproliferative disease“, PTLD) begünstigt. Dabei gibt es ein Spektrum von Läsionen, die von der Hyperplasie bis zum manifesten Lymphom reichen. Letzteres wird als monomorphe PTLD bezeichnet. Hyperplastische Veränderungen, die von viralen Reaktionen nicht zu unterscheiden sind, werden als frühe oder Mononukleose-ähnliche Läsionen bezeichnet, solche, bei denen die Lymphknotenarchitektur aufgehoben ist oder extranodale Herde entstehen, ohne dass ein lymphomartiger Phänotyp nachweisbar ist, als polymorphe PTLD. Bei den monomorphen PTLD handelt es sich entweder um hochmaligne B-Zell-Lymphome, Plasmazellneoplasien oder Hodgkin-Lymphome und nur sehr selten um T-Zell-Lymphome. Niedrig maligne B-Zell-Lymphome treten nicht auf. Eine Reduktion der Immunsuppression kann bei einem Teil der Fälle einschließlich der monomorphen PTLD den Prozess zum Stillstand bringen. Transplantation of solid organs and haematopoietic stem cells requires immunosuppressive drug therapy in order to prevent rejection or graft-versus-host disease. Depending on dosage and type of drug, the risk of developing an Epstein-Barr virus (EBV)-associated post-transplant lymphoproliferative disease (PTLD) is increased. The lesion spectrum ranges from hyperplastic lesions to manifest lymphomas, the latter being classified as monomorphic PTLD. Hyperplastic changes, which are not distinguishable from viral reactions, comprise early or mononucleosis-like lesions. Those with effaced lymph node architecture or extranodal manifestation without a lymphoma-like phenotype are designated polymorphic PTLD. Monomorphic PTLD are either high grade B cell lymphomas, plasma cell neoplasms or Hodgkin lymphomas and only very rarely T cell lymphomas. Low grade B cell lymphomas do not occur. In a subfraction of cases, including even monomorphic PTLD, reduction of immunosuppression alone is sufficient to induce remission of the pathological process. SchlüsselwörterOrgantransplantation–Posttransplantationslymphoproliferation–Epstein-Barr-Virus–Lymphome–Immunsuppression KeywordsOrgan transplantation–Post-transplant lymphoproliferative disease–Epstein-Barr virus–Lymphoma–ImmunosuppressionDer Pathologe 03/2011; 32(2):152-158. · 0.64 Impact Factor