Post Transplant
Lymphoproliferative
Disorders
(PTLD)
PTLD
 PTLD
is a group of
lymphoproliferative disorders that
range from hyperplasias to aggressive
non-Hodgkin’s lymphoma
 PTLD is seen after both solid organ
and stem cell transplant
 90% of PTLDs are Ebstein-Barr Virus
(EBV) positive
Incidence
 PTLD
occurs in 1% to 25% of solid
organ transplant patients
 PTLD occurs in < 2% of stem cell
transplant patients
 Incidence is 4 times higher in
pediatric transplant patients versus
adults
Incidence by Type of
Organ Transplanted
 Intestinal
 Lung
transplant 18%
8%
 Heart 3%
 Liver 3%
 Renal <1%
Clinical Presentation
Some patients are asymptomatic
 Others may have non specific symptoms

 Fever
 Malaise
 Weight loss
May resemble infectious mononucleosis
 Enlarged tonsils
 Lymphadenopathy
 Intestinal Perforation

Systems Potentially
Involved in PTLD
Central Nervous System
 Bone Marrow
 Kidneys
 Liver
 Lungs
 Small intestines
 Spleen

Characterization
 Early
PTLD presents within one year
following transplantation
◦ 60% develop within one year
 Late PTLD occurs more than one
year post transplant
◦ 30% develop within 1 to 5 years
◦ 10% develop after 5 years
Risk Factors
 EBV
seronegative recipient
 Type of Organ transplanted
 Type of immunosuppression
 Simultaneous cytomegalovirus
disease
 Younger Age
 Male
Prevention/Monitoring

EBV Surveillance
◦ Monitor EBV-DNA load

EBV vaccine
◦ Not standard treatment

Anti-viral agents
◦ Questionable value
◦ Agents used include Acyclovir &
Ganciclovir
Treatment of PTLD
Reduction of Immunosuppression therapy
 Anti-viral agents and IVIG are of limited
value
 Interferon alpha
 Rituximab
 CHOP

◦ Doxorubicin, Cyclophosphamide,Vincristine
and Prednisone
Conclusion
 Prognosis
is poor
 5 year survival rates
◦ 25 to 60%
 High mortality rate
 Lack of standard treatment
References
Bakker, N.A., van Imhoff, G.W., Verschuuren, E.A.M., & van Son, W. (2006). Presentation
and early detection of post transplant lymphoproliferative disorder after solid organ
transplantation.Transplant International, 20, 207-218
Everly, M.J., Bloom, R.D., Tsai, D.E. & Trofe, J. (2007). Posttransplant Lymphoproliferative
Disorder. The Annals of Pharmacotherapy, 41, 1850-1858
Faye, A. & Vilmer, E. (2005). Post-Transplant Lymphoproliferative Disorder. Pediatric
Drugs, 7, 1, 55-65
Gottschalk, S., Rooney, C.M., & Heslop, H.E. (2005). Post-Transplant Lymphoproliferative
Disorders, 56, 29-44
Lee, J.J., Lam, M.S.H., & Rosenberg, A. (2007). Role of Chemotherapy and Rituximab for
Treatment of Posttransplant Lymphoproliferative Disorder in Solid Organ
Transplantation. The Annals of Pharmacotherapy, 41, 1648-1659
Shroff, R. & Rees, L. (2003). The post-transplant lymphoproliferative disorder – a
literature review. Pediatric Nephrology, 19, 369 -377