Management and outcome of liver recipients with post-transplant lymphoproliferative disease

BACKGROUND/AIMS: The possibility of development of post-transplant lymphopr oliferative disease by patients receiving immunosuppressive therapy is well known. However, elective treatment and outcome remain controversial. We re viewed the management and outcome of our patents with posttransplant lympho proliferative disease. METHODOLOGY: Records of 457 patients who underwent orthotopic, liver transp lantation from 1986 to 1997 were analyzed, Patients who developed post-tran splant: lymphoproliferative disease were reviewed retrospectively. Incidenc e, clinical presentation, risk factors and outcomes were examined with spec ial emphasis on ductopenic rejection and hilum involvement RESULTS: Eleven patients developed a post-transplant lymphoproliferative di sease (2.4%). These were B-cell non-Hodgkins lymphoma, Epstein-Barr virus-a ssociated in all cases. Five patients (45.5%) received monoclonal antibodie s or antithymocyte globulin. Seven-patients (63.6%) developed a lymphoproli ferative disease before 9 months post-transplant and 4 recipients (36.4%) a fter 20 months. NO late lymphomas regressed after withdrawal from immunosup pression. Six patients (54.59%) were treated with chemotherapy. Eight patie nts (72.7%) had a tumoral remission. Five patients (45.5%) developed chroni c rejection after immunosuppressant discontinuation. Four of them died as a consequence of ductopenic rejection and retransplantation was required in another; 2 died due to graft hilum infiltration. Five patients (45.5%) are; alive after a follow-up of 36.5+/-32 months (range: 4-77 months). CONCLUSIONS: Patients with post-transplant lymphoproliferative disease requ ire a close follow-up in order to promptly treat conditions that could lead to death. In our series, these were more closely associated with a failing transplanted organ than with the lymphoma itself.