title: Epstein-barr virus-associated posttransplant lymphoproliferative disorder of donor origin after simultaneous pancreas-kidney transplantation limited to pancreas allograft: A case report.
abstract: A 45-year-old man was admitted with fever and elevated pancreas enzymes 6 months after simultaneous pancreas-kidney transplantation (SPKT). Function of the allografts was normal. Bacterial and fungal infections were excluded, while Epstein-Barr virus (EBV)-polymerase chain reaction (PCR) was positive. However, screening for EBV-associated lymphoma was negative. EBV infection did not respond to antiviral therapy. After an 18F-Fluorodeoxyglucose positron emission tomography positive signal and an abnormal computed tomography scan of the pancreas transplant, a biopsy revealed a diffuse large monomorphic B-cell lymphoma, which was confined to the grafted organ. Its origin was assigned to the donor by microsatellite analysis. Reduction of immunosuppression and immunotherapy with rituximab was unsuccessful. After 10 weeks, the patient developed an acute hemolytic uremic syndrome which required explantation of the allografts. Subsequent to the intervention, fever disappeared, EBV DNA became undetectable and lymphoma screening remained negative. In posttransplant lymphoproliferative disorder of donor origin after SPKT, transplantectomy may be a curative therapy.
authors.affiliation: Department of Nephrology, University Hospital of Frankfurt/Main, Germany.
authors.forename: B
authors.initials: B
authors.lastname: Rehbinder
authors.forename: Ch
authors.initials: Ch
authors.lastname: Wullstein
authors.forename: W O
authors.initials: WO
authors.lastname: Bechstein
authors.forename: M
authors.initials: M
authors.lastname: Probst
authors.forename: K
authors.initials: K
authors.lastname: Engels
authors.forename: S
authors.initials: S
authors.lastname: Kriener
authors.forename: N
authors.initials: N
authors.lastname: Döbert
authors.forename: W
authors.initials: W
authors.lastname: Schwarz
authors.forename: V
authors.initials: V
authors.lastname: Brixner
authors.forename: D
authors.initials: D
authors.lastname: Steffan
authors.forename: S
authors.initials: S
authors.lastname: Gauer
authors.forename: H
authors.initials: H
authors.lastname: Geiger
authors.forename: I A
authors.initials: IA
authors.lastname: Hauser
mesh_terms: D000328:Adult; D001706:Biopsy; D002051:Burkitt Lymphoma / Q000175:diagnosis / Q000209:etiology* / Q000821:virology; D004279:DNA, Viral / Q000032:analysis; D003922:Diabetes Mellitus, Type 1 / Q000601:surgery; D003937:Diagnosis, Differential; D005500:Follow-Up Studies; D004854:Herpesvirus 4, Human / Q000235:genetics; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D016035:Pancreas Transplantation / Q000009:adverse effects*; D049268:Positron-Emission Tomography; D014057:Tomography, X-Ray Computed; D014184:Transplantation, Homologous
chemical_list: D004279:DNA, Viral