Posttransplant Lymphoproliferative Disorder Following Kidney Transplant

(A-C) Photomicrographs of monomorphic posttransplant lymphoproliferative disorder (PTLD) in a 54-year-old man show typical staining patterns. (A) Hematoxylin and eosin stain shows sheets of large atypical cells. (B) CD20 immunohistochemistry shows numerous cells with surface membrane staining, indicating a B-cell lesion. (C) In situ hybridization identifies Epstein-Barr virus (EBV)-encoded RNA (EBER; also known as EBV latency-associated RNA) expression in most cells. This staining pattern is nuclear and identifies EBV-infected cells. (D) Hodgkin-like PTLD shows large binucleate cells (Reed-Sternberg cells) scattered within an inflammatory infiltrate. (E) Polymorphic PTLD shows different phases of B-cell maturation with cellular atypia and distortion of the normal lymphoid architecture. (Courtesy of Dr Dale Frank).

A suggested algorithm for the diagnosis and treatment of posttransplant lymphoproliferative disorder (PTLD). Clinical presentation is highly variable and all patients should undergo a diagnostic biopsy, imaging, and laboratory tests for staging and prognostication (see Box 2 for more details). Patients with 0-1 poor prognostic features and no signs of rejection can be treated with reduction of immunosuppression initially. Other patients should be treated with rituximab and/or cytotoxic chemotherapy according to their disease features. Selected cases can be treated with surgery or radiotherapy, either alone or in combination with other modalities. Abbreviations: CNS, central nervous system; CT, computed tomography; EBV, Epstein-Barr virus; LDH, lactate dehydrogenase; PCR, polymerase chain reaction; PET, positron emission tomography; XRT, radiotherapy. Adapted and reproduced from Tsai et al⁵² with kind permission of Springer Science and Business Media.