Diagnosis and treatment of posttransplant lymphoproliferative diseases after kidney transplantation: a single-center experience
10.3760/cma.j.cn421203-20240610-00145
- VernacularTitle:肾移植术后淋巴组织增生性疾病的单中心诊疗经验
- Author:
Jinpeng TU
1
;
Hong ZHENG
1
;
Qi DENG
1
;
Shunli FAN
1
;
Zhihao HUO
1
;
Jie ZHAO
1
;
Di WU
1
Author Information
1. 天津市第一中心医院移植肿瘤科 300192
- Publication Type:Journal Article
- Keywords:
Kidney transplantation;
Post-transplant lymphoproliferative disorder;
Epstein-Barr virus;
Immunosuppressant
- From:
Chinese Journal of Organ Transplantation
2025;46(9):658-664
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To summarize the clinical characteristics, diagnostic and therapeutic approaches, and prognosis of posttransplant lymphoproliferative disease (PTLD) following kidney transplantation.Methods:A retrospective case series analysis was conducted on 7 PTLD patients after kidney transplantation treated in the Department of Transplant Oncology, Tianjin First Central Hospital between January 2018 and December 2023. Clinical features, laboratory findings, imaging and pathological characteristics, treatment modalities, and outcomes were analyzed.Results:Among 7 PTLD patients, there were 5 male and 2 females with a median age of 41 (17-65) years. The median time of onset after operation was 4 (0.5-11) years. Among them, 2 patients had early onset (<1 year post-transplantation) and 5 patients had late onset (>1 year). The clinical manifestations included abdominal mass in 4 cases, anemia in 4 cases, fever in 3 cases, lymphadenopathy in 4 cases, gastrointestinal bleeding in 1 case, abdominal pain in 2 cases, and intestinal obstruction in 2 cases. Pathological types included diffuse large B-cell lymphoma in 4 cases, Burkitt lymphoma in 1 case, marginal zone lymphoma in 1 case, and polymorphic PTLD in 1 case. Reducing the immunosuppressant level was the basal treatment plan, and rituximab, chemotherapy, surgery, radiotherapy and CD19-targeted chimeric antigen receptor therapy were given according to the pathological classification. Until the date of submission, 2 patients had died, 4 had a complete response, and 1 had a partial response. None of the patients had acute rejection, and 1 patient had chronic renal insufficiency.Conclusions:PTLD after kidney transplantation presents with nonspecific manifestations, necessitating prompt imaging and histopathological evaluation for definitive diagnosis. At the same time, a series of measures should be given to improve the prognosis, including discontinuous use of anti-metabolic drugs, dosage decline of calcitric phosphatase inhibitor by 50% or convert it to sirolimus treatment, and corresponding treatment according to the specific conditions of the recipient.
