Post-transplant lymphoproliferative disease
Post-transplant Lymphoproliferative Disease Post-transplant lymphoproliferative disease (PTLD) is a rare but serious complication that can occur after an organ transplant. It is characterized by the uncontrolled proliferation of lymphoid cells, often associated with the Epstein-Barr virus (EBV). PTLD can range from benign polyclonal hyperplasia to aggressive monoclonal lymphomas.
Pathophysiology[edit | edit source]
PTLD is primarily driven by the immunosuppressive therapy required to prevent organ rejection. This immunosuppression reduces the body's ability to control EBV-infected B cells, leading to their proliferation. In most cases, PTLD is associated with EBV, although EBV-negative cases do occur.
Epstein-Barr Virus[edit | edit source]
Epstein-Barr virus is a herpesvirus that infects B cells and is commonly associated with infectious mononucleosis. In the context of immunosuppression, EBV can drive the proliferation of B cells, leading to PTLD.
Clinical Presentation[edit | edit source]
The clinical presentation of PTLD can vary widely, from asymptomatic lymphadenopathy to severe organ dysfunction. Common symptoms include fever, lymphadenopathy, and weight loss. PTLD can affect any organ, but it most commonly involves the lymph nodes, liver, and gastrointestinal tract.
Diagnosis[edit | edit source]
Diagnosis of PTLD involves a combination of clinical evaluation, imaging studies, and histopathological examination of affected tissues. A biopsy is often required to confirm the diagnosis and to determine the clonality of the lymphoid proliferation.
Treatment[edit | edit source]
Treatment of PTLD typically involves reducing immunosuppression to allow the immune system to control the proliferation of lymphoid cells. In some cases, antiviral therapy against EBV or chemotherapy may be required. Rituximab, a monoclonal antibody against CD20, is often used in the treatment of B-cell PTLD.
Prognosis[edit | edit source]
The prognosis of PTLD varies depending on the type and extent of the disease, as well as the response to treatment. Early diagnosis and management are crucial for improving outcomes.
Prevention[edit | edit source]
Preventive strategies for PTLD include careful monitoring of EBV viral loads in transplant recipients and adjusting immunosuppressive therapy accordingly. Some centers use prophylactic antiviral therapy in high-risk patients.
See Also[edit | edit source]
External Links[edit | edit source]
- [Link to a reputable source on PTLD]
NIH genetic and rare disease info[edit source]
Post-transplant lymphoproliferative disease is a rare disease.
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Contributors: Prab R. Tumpati, MD
