Posttransplant lymphoproliferative disorder localized near the allograft in renal transplantation

Background. Posttransplant lymphoproliferative disorder (PTLD), a complicat ion of immunosuppression, develops in approximately 1% of renal allograft r ecipients. Typically, PTLD is a proliferation of B-cells associated with Ep stein-Barr virus (EBV) infection; it is said to be most often a systemic di sease, Involvement occasionally is localized near the allograft, Methods. This is a retrospective analysis of all cases of PTLD in recipient s of 1474 renal transplants performed at University of Alabama at Birmingha m between 1993 and 1997, Results. Of 14 patients developing PTLD, 10 had disease localized near the allograft, The mean interval from transplantation to diagsnosis was 221 +/- 70 days. All patients presented with renal dysfunction; an ultrasound exam ination revealed a hilar mass, with hydronephrosis in five and stenosis of renal vessels in eight. No patient had lymphadenopathy, according to comput erized tomographic or magnetic resonance imaging findings. After reduction of immunosuppressive therapy, seven required a nephrectomy because of rejec tion, progressive dysfunction, or mass enlargement. Tissue recovered ill fo ur patients was consistent with PTLD; the tumors in the remaining three pat ients were unresectable and regressed. One patient died 1 month after a nep hrectomy, and another died 4 years after surgery; neither had evidence of P TLD when they died. Three patients retain functional grafts without clinica l or radiographical evidence of progression. All patients with disseminated disease died. Conclusions. In a large cohort of renal allograft recipients, PTLD affected 1%, Disease localized near the allograft was the most common variant. For most patients with localized disease, the outcome was graft loss, and the m ortality was low. Localized PTLD should be considered in the differential d iagnosis of allograft dysfunction in the 1st posttransplant year.