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Review
. 2020 Apr;36(2):229-237.
doi: 10.1007/s12288-019-01182-x. Epub 2019 Sep 17.

Post Transplant Lymphoproliferative Disorder

Devika Gupta  1 , Satish Mendonca  2 , Sushmita Chakraborty  3 , Tathagata Chatterjee  1
Affiliations
Review

Post Transplant Lymphoproliferative Disorder

Devika Gupta et al. Indian J Hematol Blood Transfus. 2020 Apr.

Abstract

Posttransplant lymphoproliferative disorder is an extremely fatal complication arising in transplant recipients as a side effect of immunosuppression. PTLDs are seen after both solid organ and hematopoietic stem cell transplants though the incidence is much higher in the former. Primary Epstein-Barr virus (EBV) infection or reactivation due to a state of immune dysregulation along with intensity of immunosuppression used are of paramount importance in pathogenesis of PTLD. EBV associated PTLDs occur early in the post transplant period whereas late onset lymphomas are usually EBV negative. The uncontrolled B cell proliferation can create a spectrum of histological patterns from nondestructive lesions to destructive polymorphic or more aggressive monomorphic PTLDs. Early detection of seropositivity by serial monitoring in the recipient can prevent PTLD development by starting pre-emptive therapy. The mainstay treatment in established cases remains reduction of immunosuppression. Chemotherapeutic and immunomodulatory agents are added sequentially based on the type of PTLD and based on its response to initial therapy. Despite various treatment options available, the morbidity remains high and achieving state of disease remission without causing graft rejection can be quite challenging. Hence, a better understanding in pathobiology of EBV+ versus EBV- PTLDS may help prevent lymphomagenesis in transplant recipients.

Keywords: Epstein–Barr virus (EBV); Hematopoietic stem cell transplant; Immunosuppression; Post transplant lymphoproliferative disorder; Rituximab; Solid organ transplant.

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Conflict of interest statement

Conflict of interestThe authors declare that they have no conflicts of interest.

Figures

Fig. 1
Fig. 1
Pathophysiology of Epstein–Barr positive PTLDs developing in solid organ transplant recipients
See this image and copyright information in PMC

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