Biliary stricture secondary to donor B-cell lymphoma after orthotopic liver transplantation

Biliary complications after orthotopic liver transplantation (OLT) lead to considerable morbidity and occasional mortality after surgery. Bile duct st rictures secondary to localized lymphoproliferative disorder of the porta h epatis is rare, with only 12 cases reported in the English Literature. Post transplant lymphoproliferative disorder develops in up to 9% of liver allog raft recipients. We describe 2 adult patients who developed Epstein-Barr vi rus-associated localized B-cell lymphoma of donor-tissue origin confined to the porta hepatis 3 and 5 months after OLT. Both patients mere administere d cyclosporine (CyA) and prednisone as primary immunosuppression. One patie nt was administered basiliximab as induction therapy. Neither patient had C yA trough levels greater than 250 ng/mL, Both patients were treated with a hepatojejunostomy, 75% reduction in immunosuppression therapy, and acyclovi r, One patient had complete involution of the tumor, and the second patient had an 80% reduction of the tumor at the 2-year follow-up visit. This repo rt illustrates the need to consider localized lymphoma post-OLT as a cause of obstructive jaundice even within the first 6 months after surgery. Aggre ssive reduction of immunosuppression in conjunction with acyclovir remains a highly effective therapy.