Post Transplant Lymphoproliferative Disease (PTLD) - Pearls

• incidence after solid organ tx is highest in lung tx>>heart>>kidney 
• risk is most related to the degree of immunosuppression and the pt's pre-transplant EBV status
• pediatric patients are at higher risk, primarily b/c most of them are EBV-negative at time of transplant
• PTLD is almost always a B-cell neoplasm, and is associate with EBV in >80% of cases
• PTLD consists of a wide variety of lymphoproliferative diseases.  The WHO classifies them into 3 categories: early lesions (plasmocytic hyperplasia, or mononucleosis-like lesions), monomorphic PTLD: B-cell neoplasms (diffuse large B-cell lymphoma, Burkitt lymphoma, plasma cell myeloma etc.) and polymorphic PTLD (having multiple cell types, often related to primary EBV infxn)

(Victoria Kelly MD, 11/2/10)