Published online Feb 28, 2020. doi: 10.5500/wjt.v10.i2.29
Peer-review started: September 17, 2019
First decision: October 14, 2019
Revised: October 21, 2019
Accepted: December 13, 2019
Article in press: December 13, 2019
Published online: February 28, 2020
Transplant recipients are vulnerable to a higher risk of malignancy after solid organ transplantation and allogeneic hematopoietic stem-cell transplant. Post-transplant lymphoproliferative disorders (PTLD) include a wide spectrum of diseases ranging from benign proliferation of lymphoid tissues to frank malignancy with aggressive behavior. Two main risk factors of PTLD are: Firstly, the cumulative immunosuppressive burden, and secondly, the oncogenic impact of the Epstein-Barr virus. The latter is a key pathognomonic driver of PTLD evolution. Over the last two decades, a considerable progress has been made in diagnosis and therapy of PTLD. The treatment of PTLD includes reduction of immunosuppression, rituximab therapy, either isolated or in combination with other chemotherapeutic agents, adoptive therapy, surgical intervention, antiviral therapy and radiotherapy. In this review we shall discuss the prevalence, clinical clues, prophylactic measures as well as the current and future therapeutic strategies of this devastating disorder.
Core tip: Post-transplant lymphoproliferative disorders (PTLD) is a serious complication related to the intensity of post-transplant immunosuppression. The role of Epstein-Barr virus (EBV) in PTLD evolution is well established; however, development of PTLD in EBV negative patients is not uncommon. The key step in the management of PTLD is to reduce the immunosuppressive load. Transplant clinicians should be vigilant to the possibility of this complication, particularly in patients with past history of exposure to immunosuppression during treatment of the primary renal disease. High index of suspicion is crucial for timely diagnosis. Therapeutic options include rituximab, chemotherapy, antivirals, adoptive therapy and surgery.