Simultaneous development of lymphoma in recipients of renal transplants from a single donor: donor origin confirmed by human leukocyte antigen staining and microsatellite analysis.
BACKGROUND
Posttransplant lymphoproliferative disorders (PTLD) occur in 0.5% to 2.5% of cases in renal-transplant recipients. Epstein-Barr virus (EBV) is usually detected in the tumor cells, suggesting a role for this virus as an agent of B-cell proliferation. It is unusual for patients receiving allografts from the same donor to develop PTLD simultaneously.


METHODS
we describe two patients who received renal allografts from the same donor and developed PTLD simultaneously. The presence of EBV in both tumors was confirmed. In this report, the origin of tumor cells was determined by immunohistochemical human leukocyte antigen (HLA) typing and microsatellite analysis. Clonality was studied by immunoglobulin gene rearrangement analysis.


RESULTS
Our results suggest that the tumor originated from donor cells in both patients but, because immunoglobulin gene rearrangements were different, this could mean that lymphoid cells proliferate independently in each recipient.


CONCLUSIONS
We propose the following pathogenesis: immortalization of passenger B lymphocytes by EBV, proliferation of these cells, and development of PTLD by means of immunosuppression, antigenic stimulation, and HLA mismatch.
Caillard
Sophie
S
Department of Nephrology and Transplantation, Hôpitaux Universitaires de Strasbourg, France. sophie.caillard@chru-strasbourg.fr
Pencreach
Erwan
E
Braun
Laura
L
Marcellin
Luc
L
Jaegle
Marie-Lorraine Woehl
ML
Wolf
Philippe
P
Parissiadis
Anne
A
Hannedouche
Thierry
T
Gaub
Marie-Pierre
MP
Moulin
Bruno
B
D000328:Adult; D005260:Female; D015321:Gene Rearrangement; D005803:Genes, Immunoglobulin; D006680:HLA Antigens / Q000032:analysis*; D006801:Humans; D007150:Immunohistochemistry; D016030:Kidney Transplantation / Q000009:adverse effects*; D008223:Lymphoma / Q000209:etiology*; D008297:Male; D018895:Microsatellite Repeats; D008875:Middle Aged; D014019:Tissue Donors
D006680:HLA Antigens