Solid organ transplantation

A1 A PTLD is a lymphoma affecting transplant recipients. It occurs in ~1% of transplant recipients, but ranges of 1%-10% have been reported. It is associated with EBV infection and the incidence is higher in children who are more likely to be seronegative for EBV exposure at the time of transplant, and who have a longer post-transplant lifespan for development of disease. PTLD is most common in small-bowel transplantation (up to ~20% incidence), presumably due to the large lymphoid mass that accompanies the organ and increased levels of immunosuppression needed for these transplants. Initial treatment is reduction of immunosuppression. Additional treatment options include surgery, radiation, chemotherapy, antibody therapy directed at B-cells, and therapy to reduce EBV load. Prognosis depends on location of disease (central nervous system, disseminated, localised), clonality (monoclonal vs. polyclonal), and subset of cells involved (T-cells, B-cells, lymphocyte subsets).