Makindo Medical Notes

The incidence of PTLD is highest in the first year after transplantation, when it is associated with the highest levels of immunosuppression.

About

• Potentially life-threatening complication in solid organ recipients.
• PTLD is the most common malignancy complicating solid organ transplantation.
• Affects approximately 10% of solid organ recipients.

Aetiology

• Strongly associated with Epstein–Barr virus (EBV) infection.
• Leads to uncontrolled B-cell proliferation and potential tumor formation.
• More common in younger patients, as adults often have immunity and are at a lower risk of this complication.

Risk Factors

• 1.5% incidence in haematopoietic cell and liver transplants.
• 2% incidence in renal transplants.
• 4% incidence in heart transplants.
• 6% incidence in lung transplants.
• Up to 20% in intestinal or multi-organ transplants.

Forms

• Lymphoproliferative disorders.
• Infectious mononucleosis and lymphoid hyperplasia.
• Malignant lymphoma.

Clinical Presentation

• Signs of lymphoproliferative disorders.
• Symptoms include fever, night sweats, weight loss, and lymphadenopathy.
• Hepatosplenomegaly may also be present.

Investigations

• Refer to lymphoma investigation protocols for guidance.
• Common investigations may include lymph node biopsy, EBV viral load measurement, and imaging studies.

Pathology

• PTLD pathology can range from benign polyclonal proliferation to malignant monoclonal lymphoma.
• Histological examination reveals B-cell proliferation, often associated with EBV-infected cells.

Management

• Initial treatment includes reducing immunosuppression if clinically feasible.
• Specific therapies may include rituximab (anti-CD20 antibody) for B-cell targeting.
• In cases of aggressive PTLD, chemotherapy or radiotherapy may be considered as per lymphoma treatment protocols.

References

• Refer to clinical guidelines for the management of PTLD in solid organ transplant recipients.
• Consult oncology and transplant medicine literature for updated treatment approaches.