Post transplant lymphoproliferative disorder: Difference between revisions

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'''''Synonyms and Keywords:''''' PTLD


==Overview==
==Overview==
Post-transplant lymphoproliferative disorder (PTLD) is the name given to a group of [[B cell]] [[lymphoma|lymphomas]] occurring in [[Immunosuppression|immunosuppressed]] patients following [[organ transplant]].


'''Post-transplant lymphoproliferative disorder''' (PTLD) is the name given to a group of [[B cell]] [[lymphoma|lymphomas]] occurring in [[Immunosuppression|immunosuppressed]] patients following [[organ transplant]].
==Incidence and prevalence==
 
==Incidence/prevalence==
It is an uncommon condition occurring in 0.2% of patients within one year of transplant, with an annual incidence of 0.04% thereafter. The risk of developing the disease is higher in children and recipients of [[heart]] transplants.
It is an uncommon condition occurring in 0.2% of patients within one year of transplant, with an annual incidence of 0.04% thereafter. The risk of developing the disease is higher in children and recipients of [[heart]] transplants.


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==Treatment==
==Treatment==
PTLD may spontaneously regress on reduction or cessation of [[Immunosuppression|immunosuppressant]] medication, and can also be treated with addition of anti-viral therapy. In some cases it will progress to [[non-Hodgkin's lymphoma]] and may be fatal.
PTLD may spontaneously regress on reduction or cessation of [[Immunosuppression|immunosuppressant]] medication, and can also be treated with addition of anti-viral therapy. In some cases it will progress to [[non-Hodgkin's lymphoma]] and may be fatal.
==Resources==
*[http://www.guideline.gov/content.aspx?id=34206&search=ptld National Guideline Clearinghouse: EBV-associated post-transplant lymphoproliferative disease in solid organ transplant]
==Related chapters==
*[[Epstein Barr virus]]
==References==
{{reflist|2}}


{{Organ transplantation}}
{{Organ transplantation}}

Revision as of 19:25, 29 February 2012

Post transplant lymphoproliferative disorder
ICD-O: M9970/1
DiseasesDB 34154

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Synonyms and Keywords: PTLD

Overview

Post-transplant lymphoproliferative disorder (PTLD) is the name given to a group of B cell lymphomas occurring in immunosuppressed patients following organ transplant.

Incidence and prevalence

It is an uncommon condition occurring in 0.2% of patients within one year of transplant, with an annual incidence of 0.04% thereafter. The risk of developing the disease is higher in children and recipients of heart transplants.

Causes

The disease is an uncontrolled proliferation of B cell lymphocytes following infection with Epstein-Barr virus. Production of an interleukin-10, an endogenous anti-T cell cytokine, has also been implicated.

In immunocompetent patients, Epstein-Barr virus causes infectious mononucleosis, characterised by a proliferation of B-lymphocytes which is controlled by Suppressor T cells.

However, calcineurin inhibitors (tacrolimus and cyclosporine) used as immunosuppressants in organ transplantation inhibit T cell function, and can prevent the control of the B cell proliferation.

Depletion of T cells by use of anti-T cell antibodies in the prevention or treatment of transplant rejection further increases the risk of developing post-transplant lymphoproliferative disorder. Such antibodies include ATG, ALG and OKT3.

Polyclonal PTLD may form tumor masses and present with symptoms due to a mass effect, e.g. symptoms of bowel obstruction. Monoclonal forms of PTLD tend to form a disseminated malignant lymphoma.

Treatment

PTLD may spontaneously regress on reduction or cessation of immunosuppressant medication, and can also be treated with addition of anti-viral therapy. In some cases it will progress to non-Hodgkin's lymphoma and may be fatal.

Resources

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References

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