Management and outcome of liver recipients with post-transplant lymphoproliferative disease.
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.
Glez-Chamorro
A
A
Department of General Surgery, Digestive System and Abdominal Organs Transplantation, Doce de Octubre Hospital, University of Madrid, Spain. chamorro@hcs.es
Jimenez
C
C
Moreno-Glez
E
E
Glez-Pinto
I
I
Loinaz
C
C
Gomez
R
R
Garcia
I
I
Alonso
O
O
Palma
F
F
Grande
C
C
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
D007166:Immunosuppressive Agents