Posttransplant Solid Tumors

Posttransplant lymphoproliferative disorders (PTLD or PT-LPD) encompass a range of lymphoid hyperplasias and neoplasias that occur in approximately 2-5% of organ transplant patients and about 1% of bone marrow recipients. They have been described as "opportunistic neoplasms" which arise in part as a consequence of the immunosuppression required to prevent organ rejection. The following list summarizes features of these lesions.

  • The Epstein-Barr virus is thought to be an important cofactor in the development of PTLD and is present within almost all cases
  • Primary EBV infection and heavy immunosuppression are considered risk factors for PTLD
  • PTLD most commonly arises within the first posttransplant year.
  • The clinical presentation of PTLD is heterogeneous. It most often presents as one or more tumors
  • PTLD may arise in lymphoid tissues such as tonsils or lymph nodes, but frequently arises in extranodal sites
  • The organ allograft itself is often involved by PTLD
  • PTLD most commonly arise from B lymphocytes. Less commonly, tumors may arise from T cells or NK cells
  • The histologic spectrum of PTLD ranges from hyperplastic lesions, some of which resemble mononucleosis, to atypical lymphoid lesions, to lymphomas
  • Lymphomatous PTLDs most often are of the non-Hodgkins type
  • PTLD most commonly arise from recipient cells in organ transplant patients and donor cells in bone marrow recipients
  • Approaches to PTLD therapy include lowering of immunosuppression, antiviral therapy, surgical support, and antilymphoma therapy
  • Newer therapies for PTLD include cellular therapy
  • A minority of PTLD may recur
  • The long-term survival of PTLD patients is dependent upon the particular form of the disease and other factors

Please mail comments, corrections or suggestions to the TPIS administrationat the UPMC.

University of Pittsburgh.

Last Modified: Thu Jun 18 10:14:08 EDT 2009