[Epstein-Barr virus-associated posttransplant lymphoproliferative disease after renal transplantation].
A 24-year-old Japanese male was admitted to our hospital because of lymphadenopathy in his left neck. He had a nine-year history of chronic renal failure, and had received an ABO-mismatched renal allograft and splenectomy in August 2000 after one year of hemodialysis treatment. After renal transplantation, he was treated with FK506, methylprednisolone (mPSL), and mycophenolate mofetil (MMF) as an immunosuppressants for his graft maintenance. On admission, April 2001, he underwent lymphadenectomy, and the immunohistochemical studies revealed that the tumor cells expressed EBV-LMP and EBNA-2 antigens with the histology of diffuse large B-cell lymphoma. Our diagnosis was an Epstein-Barr virus (EBV)-associated posttransplant lymphoproliferative disease (PTLD), and we reduced the dose of immunosuppressive agents and treated the patient with rituximab. In this case, there may have been two principal risk factors associated with PTLD: first, the patient was treated with higher levels of immunosuppressive agents because of the ABO-mismatched transplantation, and second, he was an EBV-seronegative recipient at the time of pretransplantation.
Matsubara
Etsuko
E
First Department of Internal Medicine, Ehime University School of Medicine, Ehime, Japan.
Yakushijin
Yoshihiro
Y
Nomura
Tetsuhiko
T
Iwamasa
Kikue
K
Narumi
Hiroshi
H
Sakai
Ikuya
I
Yasukawa
Masaki
M
Fujita
Shigeru
S
Hato
Takaaki
T
Ohshima
Koichi
K
Uno
Masatoshi
M
D000017:ABO Blood-Group System; D000328:Adult; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D058846:Antibodies, Monoclonal, Murine-Derived; D000970:Antineoplastic Agents / Q000627:therapeutic use; D001787:Blood Group Incompatibility / Q000150:complications; D020031:Epstein-Barr Virus Infections / Q000209:etiology*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy; D016030:Kidney Transplantation / Q000009:adverse effects*; D008232:Lymphoproliferative Disorders / Q000209:etiology* / Q000628:therapy; D008297:Male; D011183:Postoperative Complications; D000069283:Rituximab
D000017:ABO Blood-Group System; D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D000970:Antineoplastic Agents; D000069283:Rituximab