title: Management and outcome of liver recipients with post-transplant lymphoproliferative disease.
abstract: OBJECTIVE
  The possibility of development of post-transplant lymphoproliferative disease by patients receiving immunosuppressive therapy is well known. However, elective treatment and outcome remain controversial. We reviewed the management and outcome of our patients with post-transplant lymphoproliferative disease.
  
  
  METHODS
  Records of 457 patients who underwent orthotopic liver transplantation from 1986 to 1997 were analyzed. Patients who developed post-transplant lymphoproliferative disease were reviewed retrospectively. Incidence, clinical presentation, risk factors and outcomes were examined with special emphasis on ductopenic rejection and hilum involvement.
  
  
  RESULTS
  Eleven patients developed a post-transplant lymphoproliferative disease (2.4%). These were B-cell non-Hodgkins lymphoma, Epstein-Barr virus-associated in all cases. Five patients (45.5%) received monoclonal antibodies or antithymocyte globulin. Seven patients (63.6%) developed a lymphoproliferative disease before 9 months post-transplant and 4 recipients (36.4%) after 20 months. No late lymphomas regressed after withdrawal from immunosuppression. Six patients (54.5%) were treated with chemotherapy. Eight patients (72.7%) had a tumoral remission. Five patients (45.5%) developed chronic rejection after immunosuppressant discontinuation. Four of them died as a consequence of ductopenic rejection and retransplantation was required in another; 2 died due to graft hilum infiltration. Five patients (45.5%) are alive after a follow-up of 36.5 +/- 32 months (range: 4-77 months).
  
  
  CONCLUSIONS
  Patients with post-transplant lymphoproliferative disease require a close follow-up in order to promptly treat conditions that could lead to death. In our series, these were more closely associated with a failing transplanted organ than with the lymphoma itself.
authors.affiliation: Department of General Surgery, Digestive System and Abdominal Organs Transplantation, Doce de Octubre Hospital, University of Madrid, Spain. chamorro@hcs.es
authors.forename: A
authors.initials: A
authors.lastname: Glez-Chamorro
authors.forename: C
authors.initials: C
authors.lastname: Jimenez
authors.forename: E
authors.initials: E
authors.lastname: Moreno-Glez
authors.forename: I
authors.initials: I
authors.lastname: Glez-Pinto
authors.forename: C
authors.initials: C
authors.lastname: Loinaz
authors.forename: R
authors.initials: R
authors.lastname: Gomez
authors.forename: I
authors.initials: I
authors.lastname: Garcia
authors.forename: O
authors.initials: O
authors.lastname: Alonso
authors.forename: F
authors.initials: F
authors.lastname: Palma
authors.forename: C
authors.initials: C
authors.lastname: Grande
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D004359:Drug Therapy, Combination; D020031:Epstein-Barr Virus Infections / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D005260:Female; D006084:Graft Rejection / Q000517:prevention & control; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D015994:Incidence; D016031:Liver Transplantation; D016393:Lymphoma, B-Cell / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D008228:Lymphoma, Non-Hodgkin / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D008232:Lymphoproliferative Disorders / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents