Post-transplantation lymphoproliferative disorders

Faro, A., Interferon-alpha and its effects on post-transplant lymphoproliferative disorders. Springer Semin Immunopathol, 1998. 20(3 ) 425-36. 

Capello D, Rossi D, Gaidano G. Post-transplant lymphoproliferative disorders molecular basis of disease histogenesis and pathogenesis. Hematol Oncol 2005 23 61-7. 

Faro A, Kurland G, Michaels MG, et al. Interferon-a affects the immune response in post-transplant lymphoproliferative disorder. Am J Respir Grit Care Med 1996 153 1442-7. 

Malignancies Solid tumors, post-transplant lymphoproliferative disorders... 

HODGKIN-LIKE POST-TRANSPLANT LYMPHOPROLIFERATIVE DISORDER (HL-PTLD)... 

FIGURE 5.21 Hodgkin-like post-transplant lymphoproliferative disorder. 

POST-TRANSPLANTATION LYMPHOPROLIFERATIVE DISORDERS Following organ transplantation and associated immunosuppression, a range of post-transplantation lymphoproliferative disorders can develop. Histologic,... 

Type III latency, characterized by the expression of all EBNAs and LMPs. This transcriptional pattern is characteristic for the acnite phase of infectious mono-nucdeosis but also found to be associated with post transplant lymphoproliferative disorders. 

Using the same design in patients who received kidney transplants, patient and graft survival were similar in the two groups, with superior renal function in patients treated with belatacept [5 "]. However, in this study, there were a higher incidence and grade of graft rejection and post-transplant lymphoproliferative disorders in those who received belatacept. 

In a study of alemtuzumab for the treatment of acute rejection in 15 kidney transplant recipients, the rates of malignancies in alemtuzumab-treated patients were not increased during 12 years follow-up in particular, no patients treated with alemtuzumab for acute rejection developed post-transplantation lymphoproliferative disorders [148 ]. 

Abrahamian G. Intestinal perforation associated with rituximab therapy tor post-transplant lymphoproliferative disorder after liver transplantation. Cancer Chemother Pharmacol 2009 64(4) ... 

Haldas J, Wang W, Lazarchick J (2002) Post-transplant lymphoproliferative disorders T-cell lymphoma following cardiac transplant. Leukemia Lymphoma 43(2) 447-450... 

Late episodes of acute rejection are uncommon, and usually relate to poor patient compliance or inadequate levels of immunosuppression. The pathophysiology of chronic rejection is poorly understood, and can lead to graft loss. The incidence of chronic rejection has fallen progressively to approximately 5% over the past 10 years. Over-immunosuppression can lead to opportunistic bacterial infections and increased incidence of malignant disorders. Opportunistic infections such as legionellosis, nocardiosis, and tuberculosis occur between the 1st and I2th month post-transplant. Immunosuppressive treatment can be associated with Epstein Barr virus infection, and the development of post-transplantation lymphoproliferative disorder (Fig. 4.1.8). 

Post-transplantation lymphoproliferative disorder has an incidence of 2%-8.4% in adult recipients, and may occur as early as 1 month after transplantation (Ben-Ari et al. 1999). It is a consequence of the chronic immunosuppression, which causes unregulated lymphoid expansion (especially of the B-cells), and it is strongly associated with Epstein-Barr virus infection. Severity of the disease ranges from benign mononucleosis to fulminant lymphoma. The most common form is the extrahepatic type, with encasement of the porta hepatis, which can be seen as hypoechoic soft tissue on US examinations. 

Post-transplant malignancies in HSC transplantation patients are seven times more common than primary cancer in the general population. Posttransplant malignancies include solid tumors, hematologic neoplasms, and post-transplantation lymphoproliferative disorder (PTLD) (Libshitz et al. 1978 Worthy et al. 1997). 

Post-transplantation lymphoproliferative disorder (PTLD) represents a heterogeneous group of Epstein-Barr-virus-related lymphoid tumors that occur in the setting of ineffective T-cell function... 

Fig. 6.2.19. Post-transplantation lymphoproliferative disorder (PTLD) in a 54-year-old man with multiple myeloma, 2 months after allogeneic HSC transplantation. CT scans shows multiple axilar and mediastinal adenopathies. (With permission from Franquet et al. 2005a)...

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