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Post Transplant Lymphoproliferative Disorder

  • Devika Gupta
  • Satish Mendonca
  • Sushmita Chakraborty
  • Tathagata ChatterjeeEmail author
Review
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Abstract

Posttransplant lymphoproliferative disorder is an extremely fatal complication arising in transplant recipients as a side effect of immunosuppression. PTLDs are seen after both solid organ and hematopoietic stem cell transplants though the incidence is much higher in the former. Primary Epstein–Barr virus (EBV) infection or reactivation due to a state of immune dysregulation along with intensity of immunosuppression used are of paramount importance in pathogenesis of PTLD. EBV associated PTLDs occur early in the post transplant period whereas late onset lymphomas are usually EBV negative. The uncontrolled B cell proliferation can create a spectrum of histological patterns from nondestructive lesions to destructive polymorphic or more aggressive monomorphic PTLDs. Early detection of seropositivity by serial monitoring in the recipient can prevent PTLD development by starting pre-emptive therapy. The mainstay treatment in established cases remains reduction of immunosuppression. Chemotherapeutic and immunomodulatory agents are added sequentially based on the type of PTLD and based on its response to initial therapy. Despite various treatment options available, the morbidity remains high and achieving state of disease remission without causing graft rejection can be quite challenging. Hence, a better understanding in pathobiology of EBV+ versus EBV− PTLDS may help prevent lymphomagenesis in transplant recipients.

Keywords

Post transplant lymphoproliferative disorder Epstein–Barr virus (EBV) Immunosuppression Solid organ transplant Hematopoietic stem cell transplant Rituximab 

Notes

Funding

None.

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflicts of interest.

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Copyright information

© Indian Society of Hematology and Blood Transfusion 2019

Authors and Affiliations

  • Devika Gupta
    • 1
  • Satish Mendonca
    • 2
  • Sushmita Chakraborty
    • 3
  • Tathagata Chatterjee
    • 1
    Email author
  1. 1.Department of Laboratory Science and Molecular MedicineArmy Hospital (Research and Referral)New DelhiIndia
  2. 2.Department of NephrologyArmy Hospital (Research and Referral)New DelhiIndia
  3. 3.Department of Transplant Immunology and ImmunogeneticsAll India Institute of Medical SciencesNew DelhiIndia

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