Systematic Reviews
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Transplant. Aug 18, 2022; 12(8): 268-280
Published online Aug 18, 2022. doi: 10.5500/wjt.v12.i8.268
Gastrointestinal manifestations, risk factors, and management in patients with post-transplant lymphoproliferative disorder: A systematic review
William Reiche, Abubakar Tauseef, Ahmed Sabri, Mohsin Mirza, David Cantu, Peter Silberstein, Saurabh Chandan
William Reiche, Abubakar Tauseef, Mohsin Mirza, Department of Medicine, CHI Creighton University Medical Center, Omaha, NE 68124, United States
Ahmed Sabri, David Cantu, Department of Pathology, CHI Creighton University Medical Center, Omaha, NE 68124, United States
Peter Silberstein, Division of Hematology and Oncology, Department of Medicine, CHI Creighton University Medical Center, Omaha, NE 68124, United States
Saurabh Chandan, Division of Gastroenterology and Hepatology, Department of Medicine, CHI Creighton University Medical Center, Omaha, NE 68124, United States
Author contributions: Reiche W, Tauseef A, and Sabri A involved in data acquisition; Reiche W drafted the article, final approval; Tauseef A contributed to the data acquisition; Sabri A involved in pathology figures, drafting the article; Mirza M, Cantu D, Silberstein P, Chandan S involved in critical revision, final approval.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: William Reiche, DO, Doctor, Department of Medicine, CHI Creighton University Medical Center, 7500 Mercy Road, Omaha, NE 68124, United States. reichewilliam@gmail.com
Received: January 7, 2022
Peer-review started: January 7, 2022
First decision: March 9, 2022
Revised: March 24, 2022
Accepted: August 5, 2022
Article in press: August 5, 2022
Published online: August 18, 2022
ARTICLE HIGHLIGHTS
Research background

Post-transplant lymphoproliferative disorder (PTLD) is one of the most common post-transplant malignancies within the gastrointestinal (GI) tract. PTLD is a lymphoma variant which can manifest in patients having solid organ transplantation (SOT) or hematopoietic stem cell transplantation (HSCT).

Research motivation

The current understanding of GI manifestations of PTLD including timing to development, risk factors for development, and treatment is limited by small sample size. Previous studies have noted a propensity for the GI tract to develop PTLD; therefore, more information regarding when it may develop, how it manifests, and treatments are needed especially as transplantation becomes more prevalent.

Research objectives

To identify the timing and clinical presentation of GI-PTLD, risk factors for its development, and treatment.

Research methods

We performed a systematic review after an extensive literature search.

Research results

The timing of GI-PTLD is variable but on average develops 4-5 years following SOT and may occur within 1 year after HSCT. Presentation may be insidious including nonspecific abdominal discomfort to fulminant hemorrhage, perforation, or obstruction. GI-PTLD is most likely to develop in the small intestine and stomach. Transplant type, level of induction and maintenance immunosuppression, Epstein-Barr virus-status among other risk factors increase the likelihood one may develop PTLD. PTLD is aggressive and mortality improves with early treatment which is dependent on extent of disease, and morphological subtype. The most important step of therapy is reduction of immunosuppression (RIS) which usually is effective.

Research conclusions

The presentation, imaging, and direct appearance of GI-PTLD is highly variable making clinical suspicion key for diagnosis. Early detection is key for prognosis; therefore, consideration of risk factors is essential. Treatment is dependent on several factors and may include RIS, rituximab, chemotherapy, surgery, or a combination of these interventions. Initial treatment is intuitive and technically easy; however, RIS can be associated with acute graft rejections.

Research perspectives

This study suggests ascertainment of risk factors is crucial for increasing clinical suspicion when assessing patients who may have GI-PTLD. The clinical and radiological presentation of GI-PTLD is highly variable; therefore, a high index of suspicion for GI-PTLD must be maintained so that early endoscopic diagnosis may allow for targeted treatment. Future prospective studies are needed to better elucidate incidence rates of GI-PTLD and the role of endoscopy in treatment.