Liver Posttransplant Lymphoproliferative Disorder（Clinicopathologic Analysis of 3 Cases)_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 LUOLin , WANGHai-Chuan , YANGJia-yin ,  WUHong.

Department of Hepatic Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China;

Corresponding author：

WUHong., Email: wuhong7801@163.com

Keywords：

Liver transplantation; Lymphoma; Diagnosis; Treatment; Rituximab; EB virus

DOI：

10.7507/1007-9424.20150379

Video：

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Objective To summarize experience of clinical diagnosis and treatment for liver posttransplant lymphoproliferative disorder(PTLD). Method The clinical diagnosis and treatment processes of 3 patients with live PTLD in this hospital were retrospectively analyzed and the relevant literatures were reviewed. Results The EB virus was negative and CD20 was positive for these 3 patients with liver PTLD, the time of onset was 10 to 12 years after liver transplantation, and the tacrolimus was given for anti-immune following liver transplantation. The pathological diagnosis was diffuse large B cell lymphoma for all the patients. Conclusions With use of large quantities of immunosuppressive drugs following liver transplantation, incidence of liver PTLD gradually rises. Meanwhile, prognosis is poor and early diagnosis is difficult. Currently, diagnosis and classification is still dependent on pathological examination. EB virus positive patients show earlier onset, while EB negative patients show later onset with a poorer prognosis. Therefore, a long-term follow-up should be conducted for early detection, and rituximab should be administrated to patients with CD20(+).

Citation： LUOLin, WANGHai-Chuan, YANGJia-yin, WUHong.. Liver Posttransplant Lymphoproliferative Disorder（Clinicopathologic Analysis of 3 Cases). CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2015, 22(12): 1443-1446. doi: 10.7507/1007-9424.20150379 Copy

1.	Newell KA, Alonso EM, Whitington PF, et al. Posttransplant lymphoproliferative disease in pediatric liver transplantation. Interplay between primary Epstein-Barr virus infection and immunosuppression. Transplantation, 1996, 62(3): 370-375.
2.	Shapiro R, Nalesnik M, Mccauley J, et al. Posttransplant lymphopro-liferative disorders in adult and pediatric renal transplant patients receiving tacrolimus-based immunosuppression. Transplantation, 1999, 68(12): 1851-1854.
3.	Jain A, Nalesnik M, Reyes J, et al. Posttransplant lymphoprolifera-tive disorders in liver transplantation: a 20-year experience. Ann Surg, 2002, 236(4): 429-437.
4.	Jain A, Reyes J, Kashyap R, et al. Long-term survival after liver transplantation in 4 000 consecutive patients at a single center. Ann Surg, 2000, 232(4): 490-500.
5.	Harris NL, Jaffe ES, Diebold J, et al. The World Health Organization classification of neoplastic diseases of the haematopoietic and lymphoid tissues: report of the clinical advisory committee meeting, airlie house, Virginia, November 1997. Histopathology, 2000, 36(1): 69-86.
6.	Loren AW, Porter DL, Stadtmauer EA, et al. Post-transplant lymphoproliferative disorder: a review. Bone Marrow Transplant, 2003, 31(3): 145-155.
7.	Lauro A, Arpinati M, Pinna AD. Managing the challenge of PTLD in liver and bowel transplant recipients. Br J Haematol, 2015, 169(2): 157-172.
8.	Harris NL, Ferry JA, Swerdlow SH. Posttransplant lymphoproli-ferative disorders: summary of Society for Hematopathology Workshop. Semin Diagnc Pathol, 1997, 14(1): 8-14.
9.	Kahan BD, Ponticelli C, Montagnino G, et al.//Kahan BD, Ponti-celli C, editors. Principles and practice of renal transplantation. Martin Dunitz, 2000.
10.	Orjuela M, Gross TG, Cheung YK, et al. A pilot study of chemoim-munotherapy（cyclophosphamide, prednisone, and rituximab) in patients with post-transplant lymphoproliferative disorder following solid organ transplantation. Clin Cancer Res, 2003, 9(10 Pt 2): 3945S-3952S.
11.	Starzl TE, Nalesnik MA, Porter KA, et al. Reversibility of lymphomasand lymphoproliferative lesions developing under cyclosporin-steroid therapy. Lancet, 1984, 1(8377): 583-587.
12.	Caillard S, Dharnidharka V, Agodoa L, et al. Posttransplant lymp-hoproliferative disorders after renal transplantation in the United States in era of modern immunosuppression. Transplantation, 2005, 80(9): 1233-1243.
13.	Taylor AL, Marcus R, Bradley JA. Post-transplant lymphoprolifera-tive disorders（PTLD) after solid organ transplantation. Crit Rev Oncol Hematol, 2005, 56(1): 155-167.
14.	Stieber AO, Boillot O, Scotti-Foglieni C, et al. The surgical implica-tions of the posttransplant lymphoproliferative disorders. Transplant Proc, 1991, 23(1 Pt 2): 1477-1479.
15.	郑虹, 淮明生, 吴迪, 等. 肝移植术后肝脏局部淋巴增生性疾病(附3例报告). 中华器官移植杂志, 2007, 28(8): 460-462.
16.	Trappe R, Oertel S, Leblond V, et al. Sequential treatment with rituximab followed by CHOP chemotherapy in adult B-cell post-transplant lymphoproliferative disorder（PTLD): the prospective international multicentre phase 2 PTLD-1 trial. Lancet Oncol, 2012, 13(2): 196-206.
17.	苗芸, 于立新, 邓文锋, 等. 国内报道移植后淋巴增殖性疾病的总结分析. 实用器官移植电子杂志, 2013, 1(5): 276-281.
18.	Preiksaitis JK, Keay S. Diagnosis and management of posttransplant lymphoproliferative disorder in solid-organ transplant recipients. Clin Infect Dis, 2001, 33(Suppl 1): S38-S46.
19.	Nalesnik MA, Makowka L, Starzl TE. The diagnosis and treatment of posttransplant lymphoproliferative disorders. Curr Probl Surg, 1988, 25(6): 371-472.
20.	Ho M, Jaffe R, Miller G, et al. The frequency of Epstein-Barr virus infection and associated lymphoproliferative syndrome after transplantation and its manifestations in children. Transplantation, 1988, 45(4): 719-727.
21.	Cacciarelli TV, Reyes J, Jaffe R, et al. Primary tacrolimus（FK506)therapy and the long-term risk of post-transplant lymphoprolifera-tive disease in pediatric liver transplant recipients. Pediatr Transplant, 2001, 5(5): 359-364.
22.	Younes BS, Mcdiarmid SV, Martin MG, et al. The effect of immunosuppression on posttransplant lymphoproliferative disease in pediatric liver transplant patients. Transplantation, 2000, 70(1): 94-99.
23.	Opelz G, Döhler B. Lymphomas after solid organ transplantation: a collaborative transplant study report. Am J Transplant, 2004, 4(2): 222-230.
24.	Scarsbrook AF, Warakaulle DR, Dattani M, et al. Post-transplanta-tion lymphoproliferative disorder: the spectrum of imaging appearances. Clin Radiol, 2005, 60(1): 47-55.

1. Newell KA, Alonso EM, Whitington PF, et al. Posttransplant lymphoproliferative disease in pediatric liver transplantation. Interplay between primary Epstein-Barr virus infection and immunosuppression. Transplantation, 1996, 62(3): 370-375.
2. Shapiro R, Nalesnik M, Mccauley J, et al. Posttransplant lymphopro-liferative disorders in adult and pediatric renal transplant patients receiving tacrolimus-based immunosuppression. Transplantation, 1999, 68(12): 1851-1854.
3. Jain A, Nalesnik M, Reyes J, et al. Posttransplant lymphoprolifera-tive disorders in liver transplantation: a 20-year experience. Ann Surg, 2002, 236(4): 429-437.
4. Jain A, Reyes J, Kashyap R, et al. Long-term survival after liver transplantation in 4 000 consecutive patients at a single center. Ann Surg, 2000, 232(4): 490-500.
5. Harris NL, Jaffe ES, Diebold J, et al. The World Health Organization classification of neoplastic diseases of the haematopoietic and lymphoid tissues: report of the clinical advisory committee meeting, airlie house, Virginia, November 1997. Histopathology, 2000, 36(1): 69-86.
6. Loren AW, Porter DL, Stadtmauer EA, et al. Post-transplant lymphoproliferative disorder: a review. Bone Marrow Transplant, 2003, 31(3): 145-155.
7. Lauro A, Arpinati M, Pinna AD. Managing the challenge of PTLD in liver and bowel transplant recipients. Br J Haematol, 2015, 169(2): 157-172.
8. Harris NL, Ferry JA, Swerdlow SH. Posttransplant lymphoproli-ferative disorders: summary of Society for Hematopathology Workshop. Semin Diagnc Pathol, 1997, 14(1): 8-14.
9. Kahan BD, Ponticelli C, Montagnino G, et al.//Kahan BD, Ponti-celli C, editors. Principles and practice of renal transplantation. Martin Dunitz, 2000.
10. Orjuela M, Gross TG, Cheung YK, et al. A pilot study of chemoim-munotherapy（cyclophosphamide, prednisone, and rituximab) in patients with post-transplant lymphoproliferative disorder following solid organ transplantation. Clin Cancer Res, 2003, 9(10 Pt 2): 3945S-3952S.
11. Starzl TE, Nalesnik MA, Porter KA, et al. Reversibility of lymphomasand lymphoproliferative lesions developing under cyclosporin-steroid therapy. Lancet, 1984, 1(8377): 583-587.
12. Caillard S, Dharnidharka V, Agodoa L, et al. Posttransplant lymp-hoproliferative disorders after renal transplantation in the United States in era of modern immunosuppression. Transplantation, 2005, 80(9): 1233-1243.
13. Taylor AL, Marcus R, Bradley JA. Post-transplant lymphoprolifera-tive disorders（PTLD) after solid organ transplantation. Crit Rev Oncol Hematol, 2005, 56(1): 155-167.
14. Stieber AO, Boillot O, Scotti-Foglieni C, et al. The surgical implica-tions of the posttransplant lymphoproliferative disorders. Transplant Proc, 1991, 23(1 Pt 2): 1477-1479.
15. 郑虹, 淮明生, 吴迪, 等. 肝移植术后肝脏局部淋巴增生性疾病(附3例报告). 中华器官移植杂志, 2007, 28(8): 460-462.
16. Trappe R, Oertel S, Leblond V, et al. Sequential treatment with rituximab followed by CHOP chemotherapy in adult B-cell post-transplant lymphoproliferative disorder（PTLD): the prospective international multicentre phase 2 PTLD-1 trial. Lancet Oncol, 2012, 13(2): 196-206.
17. 苗芸, 于立新, 邓文锋, 等. 国内报道移植后淋巴增殖性疾病的总结分析. 实用器官移植电子杂志, 2013, 1(5): 276-281.
18. Preiksaitis JK, Keay S. Diagnosis and management of posttransplant lymphoproliferative disorder in solid-organ transplant recipients. Clin Infect Dis, 2001, 33(Suppl 1): S38-S46.
19. Nalesnik MA, Makowka L, Starzl TE. The diagnosis and treatment of posttransplant lymphoproliferative disorders. Curr Probl Surg, 1988, 25(6): 371-472.
20. Ho M, Jaffe R, Miller G, et al. The frequency of Epstein-Barr virus infection and associated lymphoproliferative syndrome after transplantation and its manifestations in children. Transplantation, 1988, 45(4): 719-727.
21. Cacciarelli TV, Reyes J, Jaffe R, et al. Primary tacrolimus（FK506)therapy and the long-term risk of post-transplant lymphoprolifera-tive disease in pediatric liver transplant recipients. Pediatr Transplant, 2001, 5(5): 359-364.
22. Younes BS, Mcdiarmid SV, Martin MG, et al. The effect of immunosuppression on posttransplant lymphoproliferative disease in pediatric liver transplant patients. Transplantation, 2000, 70(1): 94-99.
23. Opelz G, Döhler B. Lymphomas after solid organ transplantation: a collaborative transplant study report. Am J Transplant, 2004, 4(2): 222-230.
24. Scarsbrook AF, Warakaulle DR, Dattani M, et al. Post-transplanta-tion lymphoproliferative disorder: the spectrum of imaging appearances. Clin Radiol, 2005, 60(1): 47-55.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Liver Posttransplant Lymphoproliferative Disorder（Clinicopathologic Analysis of 3 Cases)

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