Postransplant lymphoproliferative disorder localized near the allograft in renal transplantation.
BACKGROUND
Posttransplant lymphoproliferative disorder (PTLD), a complication of immunosuppression, develops in approximately 1% of renal allograft recipients. Typically, PTLD is a proliferation of B-cells associated with Epstein-Barr virus (EBV) infection; it is said to be most often a systemic disease. Involvement occasionally is localized near the allograft.


METHODS
This is a retrospective analysis of all cases of PTLD in recipients of 1474 renal transplants performed at University of Alabama at Birmingham between 1993 and 1997.


RESULTS
Of 14 patients developing PTLD, 10 had disease localized near the allograft. The mean interval from transplantation to diagnosis was 221 +/- 70 days. All patients presented with renal dysfunction; an ultrasound examination revealed a hilar mass, with hydronephrosis in five and stenosis of renal vessels in eight. No patient had lymphadenopathy, according to computerized tomographic or magnetic resonance imaging findings. After reduction of immunosuppressive therapy, seven required a nephrectomy because of rejection, progressive dysfunction, or mass enlargement. Tissue recovered in four patients was consistent with PTLD; the tumors in the remaining three patients were unresectable and regressed. One patient died 1 month after a nephrectomy, and another died 4 years after surgery; neither had evidence of PTLD when they died. Three patients retain functional grafts without clinical or radiographical evidence of progression. All patients with disseminated disease died.


CONCLUSIONS
In a large cohort of renal allograft recipients, PTLD affected 1%. Disease localized near the allograft was the most common variant. For most patients with localized disease, the outcome was graft loss, and the mortality was low. Localized PTLD should be considered in the differential diagnosis of allograft dysfunction in the 1st posttransplant year.
Kew
C E
CE
Department of Medicine, The University of Alabama at Birmingham, 35294-0007, USA. ckew@nrtc.com.uab.edu
Lopez-Ben
R
R
Smith
J K
JK
Robbin
M L
ML
Cook
W J
WJ
Gaston
R S
RS
Deierhoi
M H
MH
Julian
B A
BA
D000293:Adolescent; D000328:Adult; D002648:Child; D006084:Graft Rejection / Q000601:surgery; D004854:Herpesvirus 4, Human / Q000302:isolation & purification; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D007668:Kidney / Q000473:pathology / Q000821:virology; D016030:Kidney Transplantation; D008232:Lymphoproliferative Disorders / Q000139:chemically induced* / Q000175:diagnosis / Q000628:therapy / Q000821:virology; D008279:Magnetic Resonance Imaging; D009026:Mortality; D009392:Nephrectomy; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D014184:Transplantation, Homologous; D014463:Ultrasonography
D007166:Immunosuppressive Agents