Post-transplant lymphoproliferative disorders (PTLDs)
🧪 Post-Transplant Lymphoproliferative Disorder (PTLD) is most common in the first year after transplantation, when immunosuppression is highest.
📖 About
- Serious complication of solid organ transplantation ⚠️.
- Most common malignancy after solid organ transplantation.
- Occurs in ~10% of solid organ recipients.
🧬 Aetiology
- Strongly linked to Epstein–Barr Virus (EBV) infection.
- Loss of T-cell surveillance → uncontrolled B-cell proliferation.
- More common in children & young adults (less prior EBV immunity).
📊 Risk Factors by Transplant Type
- 🩸 Haematopoietic cell / liver: ~1.5%
- 🧽 Kidney: ~2%
- ❤️ Heart: ~4%
- 🫁 Lung: ~6%
- 🧑🤝🧑 Intestinal / multi-organ: up to 20%
🔎 Forms
- Polyclonal lymphoproliferative disorders.
- Infectious mononucleosis–like illness / lymphoid hyperplasia.
- Monoclonal malignant lymphoma.
⚠️ Clinical Presentation
- B symptoms: fever, night sweats, weight loss.
- Lymphadenopathy + hepatosplenomegaly.
- Signs of systemic illness, variable depending on organ involvement.
🧪 Investigations
- Lymph node biopsy → gold standard for diagnosis.
- EBV viral load (PCR monitoring).
- Imaging: CT / PET for staging.
- Follow lymphoma investigation protocols.
🧫 Pathology
- Spectrum: benign polyclonal proliferation → aggressive monoclonal lymphoma.
- Histology: B-cell proliferation often EBV+ cells.
💊 Management
- Step 1: Reduce immunosuppression if feasible 🎯.
- Step 2: Rituximab (anti-CD20) → first-line therapy in B-cell PTLD.
- Step 3: If aggressive → add chemotherapy ± radiotherapy (as for lymphoma).
- Multidisciplinary care: oncology + transplant physicians.
💡 Exam Tip: Think PTLD in a transplant patient with fever + lymphadenopathy in the first year. Always mention EBV and reducing immunosuppression first in management!
📚 References
- NICE & UK Transplant guidelines on PTLD management.
- Recent oncology & transplant medicine literature.
