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Case Reports
. 2023 Sep;39(5):535-538.
doi: 10.1007/s12055-023-01524-5. Epub 2023 Jun 14.

Posttransplant lymphoproliferative disorder in a heart transplant recipient: a case report

Manoj Kumar Sahu  1 , Sarvesh Pal Singh  1 , Amitabh Satsangi  1 , Ajay Gogia  2 , Milind Padmakar Hote  1 , Sandeep Seth  3
Affiliations
Case Reports

Posttransplant lymphoproliferative disorder in a heart transplant recipient: a case report

Manoj Kumar Sahu et al. Indian J Thorac Cardiovasc Surg. 2023 Sep.

Abstract

Malignancy in heart transplant recipients is a grave complication. Post-transplant lymphoproliferative disorder (PTLD) is the second most common tumour in adults and commonest in children. The incidence varies with the transplanted organ from 1 to 2% following kidney transplantation to as high as 10% following thoracic organ transplantation due to different immunosuppression intensity. PTLD include a wide spectrum of diseases ranging from benign proliferation of lymphoid tissue to frank malignancy with aggressive behaviour (lymphoma). Epstein-Barr virus (EBV) infection and prolonged immunosuppressant therapy are implicated in the pathogenesis of PTLD. The incidence of PTLD varies from 2.6% at 1 year to 28% at 10 years post-transplant. Seronegativity for EBV in recipients with seropositive donors increases the risk of PTLD in recipients. The majority of early-onset PTLDs (85%) are of B-cell origin and associated with EBV. Timely and accurate diagnosis with histological examination of lymphoid tissue is essential for early intervention. Reduction of immunosuppressive therapy (IST) and rituximab usually are effective in remission of PTLD. In resistant cases, chemotherapy is given with or without rituximab. Adoptive T-cell transfer represents a promising therapeutic approach. Early PTLD respond well to lowering immunosuppression and has a favourable prognosis compared to late PTLD. Five-year survival is 30% for high-grade lymphomas. The prognosis of EBV-negative lymphomas is worse. One out of 40 heart transplant recipients followed up in our centre developed PTLD. He was treated to remission and we describe this case here.

Keywords: Epstein-Barr Virus; Heart transplant; Immunosuppressive therapy; Post-transplant lymphoproliferative disorder (PTLD).

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Conflict of interest statement

Conflict of interestThere are no conflicts of interest.

Figures

Fig. 1
Fig. 1
PET images: metabolically active lymph node (red arrows) in both sides of diaphragm (Before therapy)
Fig. 2
Fig. 2
Resolution indicated by no uptake on follow-up PET scan (After completion of therapy)
See this image and copyright information in PMC

References

    1. Liu L, Liu Q, Feng S. Management of Epstein- Barr virus- related post-transplant lympho-proliferative disorder after allogeneic hematopoietic stem cell transplantation. Ther Adv Hematol. 2020 doi: 10.1177/2040620720910964. - DOI - PMC - PubMed
    1. Dierickx D, Habermann TM. Post-transplantation lymphoproliferative disorders in adults. N Engl J Med. 2018;378:549–562. doi: 10.1056/NEJMra1702693. - DOI - PubMed
    1. Ross K. For organ transplant recipients, cancer threatens long-term survival. J Natl Cancer Inst. 2007;99:421–422. doi: 10.1093/jnci/djk141. - DOI - PubMed
    1. Lund LH, Edwards LB, Kucheryavaya AY, Dipchand AI, Benden C, Christie JD, et al. The registry of the international society for heart and lung transplantation: thirtieth official adult heart transplant report 2013, focus theme: age. J Heart Lung Transplant. 2013;32:951–964. doi: 10.1016/j.healun.2013.08.006. - DOI - PubMed
    1. Crespo-Leiro MG, Alonso-Pulpón L, Vázquez de Prada JA, Almenar L, Arizón JM, Brossa V, et al. Malignancy after heart transplantation: incidence, prognosis and risk factors. Am J Transplant. 2008; 8:1031–9. - PubMed

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