title: Gastrointestinal involvement of posttransplant lymphoproliferative disorder in lung transplant recipients: report of a case.
abstract: OBJECTIVE
  Lymphoproliferative disorder is a well-recognized complication of lung transplantation. Risk factors include Epstein-Barr virus infection and immunosuppression. The gastrointestinal manifestations of post-transplant lymphoproliferative disorder in lung transplant recipients have not been fully characterized.
  
  
  METHODS
  Case presentation and 16 previously reported cases of post-transplant lymphoproliferative disorder with gastrointestinal involvement are reviewed.
  
  
  RESULTS
  Patient ages ranged from 25 to 65 (median, 52) years. Median time from lung transplantation to onset of posttransplant lymphoproliferative disorder was 36 (range, 1-109) months; 35 percent of cases (6/17) occurred within 18 months; Eighty-eight percent of patients (15/17) had positive Epstein-Barr virus serology before transplantation. In five patients (29 percent), the posttransplant lymphoproliferative disorder also involved sites other than the gastrointestinal tract. The most common gastrointestinal site of posttransplant lymphoproliferative disorder was the colon, followed by the small intestine and stomach. Clinical features included abdominal pain, nausea, and bloody diarrhea. Diagnosis was based on typical pathologic changes on gastrointestinal tract biopsy obtained mainly by colonoscopy. Treatment included a reduction in the immunosuppressive regimen in 15 of 17 cases (88 percent) and surgical resection in 10 (59 percent). One patient was untreated. Seven of 16 patients (44 percent) responded to treatment and 9 patients died. Median time from onset of posttransplant lymphoproliferative disorder to death was 70 (range, 10-85) days.
  
  
  CONCLUSIONS
  Posttransplant lymphoproliferative disorder with gastrointestinal involvement is a unique entity that should be considered in all Epstein-Barr-Virus-positive lung transplant recipients who present with abdominal symptoms. Although immunosuppressive modulation and resection can lead to remission, the risk of death is 50 percent.
authors.affiliation: Pulmonary Institute, Rabin Medical Center, Beilinson Campus, Petah Tiqwa, Israel.
authors.forename: David
authors.initials: D
authors.lastname: Shitrit
authors.forename: Ariella Bar-Gil
authors.initials: AB
authors.lastname: Shitrit
authors.forename: Ram
authors.initials: R
authors.lastname: Dickman
authors.forename: Gidon
authors.initials: G
authors.lastname: Sahar
authors.forename: Milton
authors.initials: M
authors.lastname: Saute
authors.forename: Mordechai R
authors.initials: MR
authors.lastname: Kramer
mesh_terms: D000368:Aged; D003110:Colonic Neoplasms / Q000209:etiology* / Q000473:pathology / Q000628:therapy; D006801:Humans; D016040:Lung Transplantation / Q000009:adverse effects*; D016393:Lymphoma, B-Cell / Q000209:etiology* / Q000473:pathology / Q000628:therapy; D008297:Male; D011658:Pulmonary Fibrosis / Q000601:surgery