title: Surgical management of perforated gastrointestinal posttransplantation lymphoproliferative disorder after heart transplantation.
abstract: Posttransplantation lymphoproliferative disorder (PTLD) is a relatively rare and life-threatening complication after organ transplantation. From 1999 to 2012, 45 adult patients underwent heart transplantation at our hospital. Two of the patients developed PTLD after transplantation and required emergency surgery due to intestinal perforation. These cases were informative regarding the adequate surgical management of such cases. Both cases revealed Epstein-Barr virus-related PTLD. The optimal treatment of PTLD remains controversial, and PTLD with gastrointestinal perforation could be critical because the patients are already debilitated and immunocompromised after transplantation. Therefore, the nonspecific abdominal symptoms can be diagnostic for PTLD, and proper surgical intervention should be performed immediately. We present these two suggestive and rare cases in regard to the management of perforation with PTLD and a review of literature.
authors.affiliation: Department of Gastroenterological Surgery, Osaka University, Graduate School of Medicine, Suita, Osaka, Japan.
authors.forename: Hideki
authors.initials: H
authors.lastname: Osawa
authors.forename: Mamoru
authors.initials: M
authors.lastname: Uemura
authors.forename: Junichi
authors.initials: J
authors.lastname: Nishimura
authors.forename: Taishi
authors.initials: T
authors.lastname: Hata
authors.forename: Ichiro
authors.initials: I
authors.lastname: Takemasa
authors.forename: Tsunekazu
authors.initials: T
authors.lastname: Mizushima
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Yamamoto
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Doki
authors.forename: Masaki
authors.initials: M
authors.lastname: Mori
mesh_terms: D000293:Adolescent; D020031:Epstein-Barr Virus Infections / Q000150:complications; D005767:Gastrointestinal Diseases / Q000209:etiology / Q000601:surgery*; D016027:Heart Transplantation; D006801:Humans; D016867:Immunocompromised Host; D007416:Intestinal Perforation / Q000209:etiology / Q000601:surgery*; D008232:Lymphoproliferative Disorders / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications
keywords: Intestinal perforation; Lymphoma; Lymphoproliferative disorder; Posttransplantation; Transplantation