Lymphoproliferative Disorders after Lung Transplantation: Clinicopathological Characterization of 16 Cases with Identification of Very-Late-Onset Forms.
BACKGROUND
The incidence of posttransplant lymphoproliferative disorders (PTLD) has recently declined, but late cases are increasingly reported in lung transplant recipients.


OBJECTIVE
We present our experience with PTLD after lung transplantation, attempting to examine the distinguishing characteristics of early versus late cases.


METHODS
We have reviewed clinical and pathological data of all cases occurring in our institution between 2001 and 2014.


RESULTS
Patients, aged 15-63 years, were mostly (12/16) Epstein-Barr virus (EBV) seropositive at the time of transplantation. Eleven early cases, occurring 9.4 ± 5.2 months after transplantation and mostly (9/11) prior to 2010, had EBV+ diffuse large B-cell lymphomas. Lungs and/or thoracic lymph nodes were often involved (n = 8). Treatments included reduction of immune suppression (n = 11), rituximab (n = 8) and chemotherapy (n = 7). Two patients are in complete remission at 26 and 216 months. Nine patients died 8.0 ± 6.5 months after PTLD diagnosis. Of the 5 cases with late PTLD occurring 4-23 years (mean ± SD: 10.4 ± 7.7) after transplantation (and 3/5 after 2009), 1 had pulmonary lymphomatoid granulomatosis (only endothoracic case), 1 cutaneous large T-cell lymphoma, 2 had anaplastic large cell lymphomas, and 1 Hodgkin's disease. Two of the 5 cases were EBV-, including one followed by a second EBV+ PTLD after 8 years of complete remission. Two patients were alive and well (follow-up: 44 and 151 months), one having suffered from EBV-related cholestatic hepatitis 6 years after the PTLD.


CONCLUSIONS
Our small experience shows a trend toward (very) late occurrence, associated with more unusual clinicopathologic features, but not with a worse prognosis.
Department of Pathology, Centre Chirurgical Marie Lannelongue, Le Plessis-Robinson, France.
Vincent
V
Thomas de Montpréville
Jérôme
J
Le Pavec
François
F
Le Roy Ladurie
Adrian
A
Crutu
Sacha
S
Mussot
Dominique
D
Fabre
Olaf
O
Mercier
Peter
P
Dorfmuller
Maria-Rosa
MR
Ghigna
Élie
É
Fadel
D000293:Adolescent; D000328:Adult; D020031:Epstein-Barr Virus Infections / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D004854:Herpesvirus 4, Human; D006801:Humans; D016040:Lung Transplantation / Q000009:adverse effects*; D008232:Lymphoproliferative Disorders / Q000453:epidemiology* / Q000473:pathology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors; D055815:Young Adult