Posttransplant Lymphoproliferative Disorder in Liver Transplant Recipients

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Abstract

Objective

This study was conducted to analyze the clinical characteristics, treatment and outcome of posttransplant lymphoproliferative disorder(PTLD) in liver transplant recipients. Methods: This study includes a retrospective data analysis of nine liver transplant recipients with PTLD who were treated at the Liver Transplant Center, Beijing Friendship Hospital, China, from 2013 to 2017. One patient was adult, and the others were children. Demographic, clinical, treatment data and outcome were collected.

Results

The incidence of PTLD in our liver transplant center was 7/634(1.1%),whereas the incidence of PTLD in pediatric liver transplant recipients in our liver transplant center was 6/403(1.5%).All the patients were diagnosed by pathology. Three cases were classified as early lesions of PTLD,2 cases were polymorphic PTLD, two cases were burkitt lymphoma, one case was diffuse large B cell lymphoma and one case was classical Hodgkin lymphoma-like PTLD.The mean onset time was 15months after liver transplantation (from 5 to 32 months. The paitents had different clinical manifestations mainly including fever, anemia, diarrhea, enlargement of lymph nodes or hepatosplenomegaly, jaundice, intestinal obstruction and even intestinal perforation. All the patients had positive EB-DNA in serum. After the diagnosis,immunosuppressants were reduced or discontinued.All the patients received anti-CD20(Rituximab) theraphy.Four cases were treated combined with chemotheraphy(R-CHOP,ABVD,COPP/ABV).Two cases were treated combined with radiotherapy.Two cases received surgical treatment due to intestinal obstruction.Seven patients achieved complete response and were alive at the time of review. One patient died of graft failure,and another patient died of relapse of PTLD.

Conclusion

PTLD is one of the most serious and fatal complications after liver transplantation.The detection of EB-DNA load and imaging examination can provide clues for diagnosis.Definite diagnosis can be made based on histopathology.Treatment varies according to differet classifications,and basically including immunosuppression reduction,anti-CD20 antibody,operation, radiotherapy and chemotherapy.Early detection and early-stage treatment are needed to rescue patients who have suffered from PTLD.

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