EPSTEIN-BARR VIRUS-ASSOCIATED HEPATIC SMOOTH-MUSCLE NEOPLASM IN A CARDIAC TRANSPLANT RECIPIENT

Host immunosuppression is increasingly recognized as a significant ris k factor for the development of a primary neoplasm. Chronic immunosupp ressive therapy, as used in organ transplantation, may perturb the imm unosurveillance ability of the host, making the patient more susceptib le to virus-associated malignancies. We have taken care of a child who received an orthotopic heart transplant and who then developed both a generalized lymphoproliferative disorder and a leiomyoma of the liver a year later. Epstein-Barr virus DNA was detected in a lymph node ini tially and the hepatic tumor cells subsequently. The former responded to a reduction in the immunosuppressive medications and the latter res ponded to surgical resection. This is the first report of a hepatic sm ooth cell neoplasm occurring following cardiac transplant and the deve lopment of two sequential Epstein-Barr virus-associated disorders in a n immunosuppressed patient.