POSTTRANSPLANTATION LYMPHOPROLIFERATIVE DISORDER ASSOCIATED WITH OKT3AND DECREASED ANTIVIRAL PROPHYLAXIS IN PANCREAS TRANSPLANT RECIPIENTS

Between September 1994 and October 1995, we diagnosed and treated four cases of early onset posttransplantation lymphoproliferative disorder (PTLD) occurring within 62 days of pancreas transplantation. The deve lopment of PTLD was associated with both a significantly higher total muromonab-CD3 (OKT3) dose and a lack of ganciclovir/acyclovir prophyla xis, but it was not associated with the total dose of antithymocyte gl obulin or cytomegalovirus serostatus. All four patients were treated a ggressively and survived without evidence of recurrent PTLD more than 1.5 years later. We conclude that the use of a high total dose of OKT3 puts pancreas transplant recipients at increased risk for early onset PTLD, while ganciclovir/acyclovir prophylaxis may help to prevent thi s disorder; however, if early onset PTLD does occur in these patients, aggressive therapy can lead to a favorable outcome.