EPSTEIN-BARR-VIRUS INFECTION AND MALIGNANT-LYMPHOMAS IN LIVER-TRANSPLANT RECIPIENTS

Post-transplant lymphoproliferative disease (PTLD) is a major cause of death and disease in transplant patients. We describe 4 cases with hi stologically confirmed malignant lymphoma arising in the Birmingham li ver transplant programme between 1982 and 1995, One was an EBV-positiv e diffuse large B-cell lymphoma, 2 were EBV-positive Burkitt's lymphom as and the 4th was an EBV-negative Burkitt's lymphoma, Immunohistochem istry revealed expression of the EBV-encoded latent membrane protein L MP1 and of the BZLF1 trans-activator protein in 2 cases each, whereas the virus-encoded nuclear antigen EBNA2 was not detectable. All availa ble post-transplant biopsies from the 3 patients with EBV-associated l ymphoma were then studied to test whether the detection of EBV-positiv e cells in liver allograft biopsies could be used to identify patients at risk for the development of PTLD. Two patients showed infrequent E BV-positive cells in liver allograft biopsies up to 14 months before t he occurrence of lymphoma and a marked increase in the number of such cells at the time of lymphoma diagnosis. Multiple biopsies from the 3 rd patient did not reveal any EBV-carrying cells in the entire post-tr ansplant period. Our results demonstrate a low incidence of PTLD in th e Birmingham liver transplant programme. The PTLDs were morphologicall y high-grade malignant lymphomas, Only 3 cases were associated with EB V infection, and these showed heterogeneous patterns of EBV latent pro tein expression. Our results also suggest that the examination of live r allograft biopsies using EBER in situ hybridisation is not an approp riate method for identifying patients at risk of developing PTLD. (C) 1997 Wiley-Liss, Inc.