title: Posttransplant lymphoproliferative disorder in adult liver transplant recipients: a report of seventeen cases.
abstract: Posttransplant lymphoproliferative disorder (PTLD) is a major complication of liver transplantation, but previous descriptions have been limited to case reports and small case series. We report a retrospective analysis of 17 consecutive cases of PTLD associated with liver transplantation. The median age at PTLD diagnosis was 47 years (range 19 - 63) with a median time of 25 months from liver transplantation to PTLD diagnosis (range 3 - 75). PTLD location was frequently extranodal (71%) and involved the transplanted liver (41%). PTLD histology consisted of nine (53%) monomorphic and eight (47%) polymorphic disease. EBV was present by in situ hybridization in 11 (79%) of 14 cases evaluated. Initial therapy included reduction in immunosuppression (RI) alone in 13 (76%) of 17 patients, resulting in 6 (46%) complete responses (CR) and 7 (54%) progressive disease (PD). Monoclonal CD20 antibody (rituximab) and CHOP chemotherapy were used as initial therapy or as second line after RI failure. Currently, five patients (29%) are alive in CR. Although detection and treatment of PTLD in liver transplant recipients remains problematic and upfront mortality is still high, long-term survival is possible. Further studies are necessary to better define treatment strategies.
authors.affiliation: Abramson Cancer Center, University of Pennsylvania Medical Center, Philadelphia, PA 19104, USA.
authors.forename: Himisha
authors.initials: H
authors.lastname: Patel
authors.forename: Dan T
authors.initials: DT
authors.lastname: Vogl
authors.forename: Nicole
authors.initials: N
authors.lastname: Aqui
authors.forename: Abraham
authors.initials: A
authors.lastname: Shaked
authors.forename: Kim
authors.initials: K
authors.lastname: Olthoff
authors.forename: James
authors.initials: J
authors.lastname: Markmann
authors.forename: Rajender
authors.initials: R
authors.lastname: Reddy
authors.forename: Edward A
authors.initials: EA
authors.lastname: Stadtmauer
authors.forename: Stephen
authors.initials: S
authors.lastname: Schuster
authors.forename: Donald E
authors.initials: DE
authors.lastname: Tsai
mesh_terms: D000328:Adult; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D058846:Antibodies, Monoclonal, Murine-Derived; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D003520:Cyclophosphamide / Q000627:therapeutic use; D018450:Disease Progression; D004317:Doxorubicin / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D017403:In Situ Hybridization; D016031:Liver Transplantation / Q000009:adverse effects*; D008232:Lymphoproliferative Disorders / Q000175:diagnosis* / Q000209:etiology* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011239:Prednisolone / Q000627:therapeutic use; D012008:Recurrence; D000069283:Rituximab; D016896:Treatment Outcome; D014750:Vincristine / Q000627:therapeutic use
chemical_list: D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D007166:Immunosuppressive Agents; D000069283:Rituximab; D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D011239:Prednisolone