title: [Post transplant lymphoproliferative disorder (PTLD)--10 years follow-up].
abstract: PTLD is a very severe, life threatening complication after organ transplantation. A 17 years old female patient with kidney transplanted (KTx) 7th months ago on immunosuppression therapy: Tacrolimus (TAC), Cell Cept (MMF), Encorton (Enc) was described. She was admitted to the hospital due to: fever, abdominal pain, diarrhea and enlarged cervical and inguinal lymph nodes on palpation. Histopathological diagnosis revealed monomorphic PTLD; diffuse large B cell lymphoma, immunoblastic. Treatment of PTLD was started immediatly after the final diagnosis. MMF was stopped, dose of TAC was reduced (blood level 3-4 ng/ ml), Enc were continued. Anti-CD20 antibodies (Rituximab) were administered. After 7 days of treatment the patient developed signs of diffuse peritonitis. In the course of surgery, perforation in six sites of the small intestine and sigmoid colon were discovered. The Hartman's surgery was performed (sigmoidectomy) with formation of temporary sigmoideostomy. Resected parts of intestine and sigmoid colon were infiltrated by immnunoblasts and revealed diffuse necrosis - the same process was seen in lymph nodes. After the wounds healed, Rituksymab was continued (8 doses) and chemotherapy was started - CHOP - 6 cycles every month. Eight months after surgery, full remission was obtained, TAC was change to rapamycine (RAP) and closure of sigmoideostomy was performed. At present, almost 10 years after first symptoms of PTLD, the patient remains in full remission of the disease.
authors.affiliation: Katedra i Klinika Nefrologii UJCM w Krakowie Kierownik.
authors.forename: Ewa
authors.initials: E
authors.lastname: Ignacak
authors.forename: Alina
authors.initials: A
authors.lastname: Betkowska-Prokop
authors.forename: Marek
authors.initials: M
authors.lastname: Kuźniewski
authors.forename: Zbigniew
authors.initials: Z
authors.lastname: Rudzki
authors.forename: Krzysztof
authors.initials: K
authors.lastname: Okoń
authors.forename: Aleksander
authors.initials: A
authors.lastname: Skotnicki
authors.forename: Wojciech
authors.initials: W
authors.lastname: Jurczak
authors.forename: Jan
authors.initials: J
authors.lastname: Kulig
authors.forename: Antoni
authors.initials: A
authors.lastname: Czupryna
authors.forename: Jerzy
authors.initials: J
authors.lastname: Bucki
authors.forename: Władysław
authors.initials: W
authors.lastname: Sułowicz
mesh_terms: D000293:Adolescent; D058846:Antibodies, Monoclonal, Murine-Derived / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D016030:Kidney Transplantation / Q000009:adverse effects*; D008232:Lymphoproliferative Disorders / Q000175:diagnosis / Q000276:immunology* / Q000628:therapy*; D012074:Remission Induction; D000069283:Rituximab; D012812:Sigmoidoscopy; D020123:Sirolimus / Q000008:administration & dosage; D016559:Tacrolimus / Q000009:adverse effects
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D007166:Immunosuppressive Agents; D000069283:Rituximab; D020123:Sirolimus; D016559:Tacrolimus