Acute renal allograft rejection in patients with Epstein-Barr virus associated post-transplant lymphoproliferative disorder.
BACKGROUND
There is a reciprocal relationship between post-transplant lymphoproliferative disorder (PTLD) and rejection: aggressive treatment of rejection can result in PTLD, while treatment of PTLD by reducing immunosuppression can result in recrudescence of rejection. The literature on the relationship between PTLD and rejection episodes is limited.


METHODS
The clinical course and outcome of rejection episodes occurring prior to and following a diagnosis of PTLD were studied in 20 renal transplant recipients.


RESULTS
The diagnosis of PTLD was preceded by rejection in 12/20 (60%) patients. OKT3 treatment was associated with early onset PTLD, which involved the allograft in 6/7 patients (86%). The risk of rejection following reduced immunosuppression was 7/14 (50%). Post-PTLD rejection left untreated led to graft loss in 3 patients. The remaining 4 patients responded satisfactorily to anti-rejection therapy.


CONCLUSIONS
Reduction of immunosuppression for PTLD is frequently, but not invariably, complicated by rejection. The clinical outcome of PTLD does not correlate with the occurrence or reversibility of rejection episodes.
Purighalla
R
R
Department of Pathology, University of Pittsburgh Medical Centre, Pennsylvania, USA.
Shapiro
R
R
Jordan
M L
ML
Scantlebury
V P
VP
Gritsch
H A
HA
Vivas
C
C
Randhawa
P S
PS
D000328:Adult; D000368:Aged; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006084:Graft Rejection / Q000188:drug therapy / Q000821:virology*; D006566:Herpesviridae Infections / Q000175:diagnosis / Q000209:etiology*; D004854:Herpesvirus 4, Human / Q000302:isolation & purification*; D006801:Humans; D007165:Immunosuppression Therapy / Q000009:adverse effects; D007166:Immunosuppressive Agents / Q000009:adverse effects; D016030:Kidney Transplantation / Q000009:adverse effects*; D008232:Lymphoproliferative Disorders / Q000175:diagnosis / Q000209:etiology* / Q000821:virology; D008297:Male; D008875:Middle Aged; D016853:Muromonab-CD3 / Q000009:adverse effects
D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D016853:Muromonab-CD3