Posttransplant lymphoproliferative disorder.
OBJECTIVE
To define and discuss the pathogenesis, clinical presentation, diagnosis, risk factors, and current preventive and treatment strategies of posttransplant lymphoproliferative disorder (PTLD).


METHODS
MEDLINE was searched for articles published from January 1966 to July 2007. Search terms used include posttransplant lymphoproliferative disease, posttransplant malignancy, antiviral agents, interferon-alfa, rituximab, immunosuppression, chemotherapy, radiation, and surgery. Additional articles were identified by a hand search of references.


METHODS
Studies in English of pediatric and adult solid organ transplantation populations published were selected and analyzed. Data from these studies and information from review articles were included in this review.


RESULTS
PTLD occurs in 1-20% of organ recipients following solid organ transplantation. PTLD risk factors include recipient pretransplant Epstein-Barr virus (EBV) negative serostatus, type of transplant, intensity of immunosuppression, and age. The PTLD presentation is variable. Some patients present asymptomatically; in others, early symptoms can be nonspecific. To prevent PTLD, minimizing immunosuppression burden and using antiviral agents active against EBV are useful strategies. PTLD treatment may require reduction of immunosuppression, radiation, surgical excision, monoclonal antibodies, interferon-alfa, and chemotherapy.


CONCLUSIONS
Screening for patients at risk and balancing the intensity of immunosuppressive regimens against the risk of rejection can substantially reduce the risk of developing PTLD. If PTLD occurs, an individualized treatment plan including decreased immunosuppression and other agents should be chosen based on the severity and extent of disease.
Everly
Matthew J
MJ
University of Cincinnati, Cincinnati, OH 45267, USA. matthew_everly@yahoo.com
Bloom
Roy D
RD
Tsai
Donald E
DE
Trofe
Jennifer
J
D000367:Age Factors; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D058846:Antibodies, Monoclonal, Murine-Derived; D000970:Antineoplastic Agents / Q000627:therapeutic use; D000998:Antiviral Agents / Q000627:therapeutic use; D020031:Epstein-Barr Virus Infections / Q000150:complications / Q000188:drug therapy; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use; D007166:Immunosuppressive Agents / Q000008:administration & dosage* / Q000009:adverse effects*; D015994:Incidence; D008232:Lymphoproliferative Disorders / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D016377:Organ Transplantation / Q000009:adverse effects*; D012307:Risk Factors; D000069283:Rituximab
D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D000970:Antineoplastic Agents; D000998:Antiviral Agents; D007155:Immunologic Factors; D007166:Immunosuppressive Agents; D000069283:Rituximab