Posttransplant Lymphoproliferative Disorder

Cumulative incidence over 5 y: 1–2% in liver, 1–3% in kidneys, 2–6% in heart, 2–9% in lung, and 11–33% in intestinal or multiorgan transplants

Major risk factors:

• EBV positive serology in the recipient (multisystem PTLD)

• EBV negative recipient and EBV-positive donor (PTLD limited to allograft tissue)

• The degree of T-cell immunosuppression (induction with OKT3, ATGAM, thymoglobulin, and maintenance with tacrolimus)

Additional risk factors:

• Time after transplant (highest incidence during the first y)

• Recipient age (<25 y)

• Ethnicity (Caucasians)

Overall survival rates ranging between 25–35%

Increased risk of airway or bowel obstruction and hemodynamic compromise

Increased risk of dysfunction of the transplanted organs

Increased risk for infection and CNS involvement

Enlarged tonsils and cervical adenopathy increasing difficulty of airway

Thoracic adenopathy complicating intubation, ventilation, and cardiac output

Pulm involvement causing decreased oxygenation and/or ventilation

Dysfunction of the transplanted kidneys, liver, or heart

GI involvement manifesting as N/V or bowel obstruction

CNS involvement manifesting as mental status change or increased ICP

Immunosuppression causing an increased rate of infection

Lymphoproliferative disorders are among the most serious and potentially fatal complications of chronic immunosuppression in organ transplant recipients.

These tumors are mostly B-cell-type large-cell lymphomas. Extranodal involvement occurs in 30–70% of these cases as a localized tumor in either the transplanted organ or another site, such as the GI system, lungs, skin, liver, and CNS.

B lymphocytes, infected by EBV, proliferate in the setting of immunosuppression, where T-cell immune surveillance is significantly decreased.