Post-transplant complications including neoplastic disorders such as carcinoma and lymphomas, related primarily to chronic immunosuppression, are well recognised.
Post-transplant lymphoproliferative disorders (PTLDs) are a group of lymphoid or plasmacytic proliferations that develop as a consequence of immunosuppression after receipt of a solid organ, bone marrow or stem cell allograft and for which there is no other known explanation.
PTLD encompasses polyclonal proliferations resembling infectious mononucleosis to monomorphic proliferations indistinguishable from aggressive types of lymphoma such as diffuse large B-cell lymphoma.
They are mostly of B-cell lineage. Unlike B-cell PTLD, T/NK-cell PTLD is always clonal, tends to occur later (median time from transplantation to development of PTLD is 66 months), is less likely to involve the allograft, and is less commonly associated with EBV (33% compared with 90% positivity in B-cell PTLD).
T/NK-cell PTLDs occur in patients of all ages (range 2–75 years; median 43.5 years), with most cases being after a renal transplant.
The most common sites reported include peripheral blood (22%), bone marrow (30%), spleen (28%), skin (19%), liver (18%), gastrointestinal tract (14%; most often the small intestine), lung and pleura or pleural cavities (12%), and kidney (7%).
Other less common sites are brain (5%), heart, pericardium or pericardial fluid (5%), nose or pharynx (3%), pancreas (3%), mediastinum (2%) and rarely the urinary bladder.
A T/NK-cell origin, except for those of the large granular subtype, of a PTLD is considered an adverse prognostic indicator, with an overall survival of only 6 months.
References
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Lymphoproliferative disorders after organ transplantation: a report of 24 cases observed in a single center. J Clin Oncol 1995;3:961–8.
Post-transplant lymphoproliferative disorders. In: Jaffe ES, Harris NL, Stein H, et al., eds. Swerdlow SH, Campo E, Harris NL, et al. eds. WHO Classification of Tumours of Haematopoietic and Lymphoid Tissues. Lyon: IARC, 2008:343–9.
T-cell and NK-cell post transplantation lymphoproliferative disorders. Am J Clin Pathol 2007;127:887–95.
Aggressive natural killer–like T-cell malignancy with leukemic presentation following solid organ transplantation. Am J Clin Pathol 1999;111:663–71.