Post-transplantation lymphoproliferative disorder

Post-transplantation lymphoproliferative disorder (PTLD) comprises a spectrum of Epstein-Barr virus associated B-cell proliferations occurring after organ transplantation; similar though not always identical disorders occur in congenital immunodeficiency states, and in AIDS. The disease provides insights into the nature of lymphoid neoplasia and represents a growing clinical problem. The incidence and pathogenesis of PTLD are examined in relation to the use of specific immunosuppressive regimens, and comparisons with AIDS-related lymphoma are made. Clinical manifestations, pathologic features, and diagnostic considerations are summarized. Recently developed molecular methods for accurate determination of clonal composition are reviewed, and their relevance to clinical management is outlined. A basis for the selection of existing therapeutic options including a reduction in immunosuppression, surgery, radiation, or chemotherapy, is proposed for specific clinical situations. Novel approaches to the treatment and prevention of the disease are outlined.