title: How Should We Treat Early Post-Transplant Lymphoproliferative Disease After Heart Transplantation?
abstract: Although post-transplant lymphoproliferative disease (PTLD) is one of the major fatal complications encountered several years after heart transplant (HTx), little is known about early-PTLD emerging within the first year. We here describe the rare case of a 24-year-old female patient who suffered from early-PTLD (DLBCL: diffuse large B-cell lymphoma) associated with an Epstein-Barr virus (EBV) infection, that developed around the jejunum at 7 months after HTx. She suffered from acute abdominal peritonitis due to perforation of the jejunum soon after the first chemotherapy. She was treated successfully by emergent partial resection of the jejunum and colostomy after the discontinuation of everolimus (EVL) and successive low-dose chemotherapy under careful monitoring and adjustment of intravenous immunosuppressant including cyclosporine (CyA) and prednisolone to avoid a rejection reaction. Prophylactic strategies for early-PTLD in HTx recipients should be undertaken with caution.
authors.affiliation: Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Nitta
authors.forename: Koichiro
authors.initials: K
authors.lastname: Kinugawa
authors.forename: Teruhiko
authors.initials: T
authors.lastname: Imamura
authors.forename: Masaru
authors.initials: M
authors.lastname: Hatano
authors.forename: Minoru
authors.initials: M
authors.lastname: Ono
authors.forename: Fumihiko
authors.initials: F
authors.lastname: Nakamura
authors.forename: Mineo
authors.initials: M
authors.lastname: Kurokawa
authors.forename: Issei
authors.initials: I
authors.lastname: Komuro
mesh_terms: D000328:Adult; D003125:Colostomy / Q000379:methods; D016572:Cyclosporine / Q000008:administration & dosage / Q000009:adverse effects; D016903:Drug Monitoring; D020031:Epstein-Barr Virus Infections / Q000175:diagnosis / Q000601:surgery; D000068338:Everolimus / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D006084:Graft Rejection / Q000517:prevention & control; D016027:Heart Transplantation / Q000009:adverse effects*; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000009:adverse effects; D007583:Jejunum / Q000601:surgery; D016403:Lymphoma, Large B-Cell, Diffuse / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D054539:Medication Therapy Management; D010538:Peritonitis / Q000175:diagnosis / Q000209:etiology / Q000601:surgery; D011183:Postoperative Complications / Q000175:diagnosis / Q000628:therapy; D011239:Prednisolone / Q000008:administration & dosage / Q000009:adverse effects; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents; D016572:Cyclosporine; D000068338:Everolimus; D011239:Prednisolone