POSTTRANSPLANTATION LYMPHOPROLIFERATIVE DISORDER - CHANGING MANIFESTATIONS OF DISEASE IN A RENAL-TRANSPLANT POPULATION

Objective: To review the changing manifestations of PTLD in patients w ith renal transplants. Methods: Review of 1954 records of the renal tr ansplantation clinic from 1971 to 1993 produced 17 patients with the d iagnosis of PTLD. Results: With changes in immunosuppression, the site s of involvement of PTLD have changed. Central nervous system involvem ent was the predominant site of disease prior to the use of cyclospori ne. With the institution of cyclosporine, thoracic, and abdominal pres entations became more common. PTLD isolated to the renal transplant is a new manifestation of disease that may be a result of immunosuppress ion with OKT3. Monomorphous PTLD was associated with a 78% PTLD relate d mortality. Polymorphous PTLD had a 0% PTLD related mortality. In pat ients with cross-sectional imaging abnormalities, PTLD presented as so litary or multiple masses in 78%. This is the finding most suggestive of PTLD in a transplant population. Conclusion: Posttransplantation ly mphoproliferative disorder is a heterogeneous grouping of lymphoid pro liferation with variable clinical and radiographic manifestations. An understanding of the range of manifestations may lead to improved diag nosis of this unusual disorder.