Clinical Analysis of Posttransplant Lymphoproliferative Disorder After Liver Transplant.

Abstract

Objectives: Posttransplant lymphoproliferative disorder is a severe and potentially fatal complication after liver transplant, resulting from immunosuppression-driven uncontrolled lymphoid proliferation. In this study, we aimed to analyze the incidence, clinico-pathological characteristics, management, and outco-mes of posttransplant lymphoproliferative disorder in liver transplant recipients.

Materials and methods: We conducted a retrospective analysis of 1288 patients who underwent liver transplant between January 2015 and December 2024. Among them, 8 recipients (0.62%) were diagnosed with posttransplant lymphoproliferative disorder based on histopathological and clinical criteria. Baseline characteristics, clinicopathological characteristics, management, and outcome data were collected and statistically evaluated.

Results: Age at time of transplant was 55.5 years (range, 44-62 years), and posttransplant lymphoproliferative disorder was diagnosed at 10.5 months posttransplant (interquartile range, 7.5-28.5 mo; range, 5-44 mo). Clinical manifestations were diverse and nonspecific, with 6 having allograft involvement (75%) and 7 having detectable Epstein-Barr virus positivity (87.5%). Monomorphic B-cell posttransplant lymphoproliferative disorder (B-cell lymphomas and diffuse large B-cell lymphoma) was the most common subtype (87.5%). All recipients with posttransplant lymphoproliferative disorder received immunosuppression reduction or withdrawal. Three patients with diffuse large B-cell lymphoma-type received chemotherapy, 1 with central nervous system-type received rituximab plus cyclophosphamide, and 1 received rituximab combined with radiofrequency ablation for liver lesions. Of the 8 recipients, 3 had remission and 5 died due to sepsis complications and posttransplant lymphoproliferative disorder. Median time from diagnosis of posttransplant lymphoproliferative disorder to death was 2 months (range, 1.5-5.5 mo).

Conclusions: Posttransplant lymphoproliferative disor-der, characterized by heterogeneous manifestations, remains a serious complication after liver transplant. Early diagnosis requires a combination of Epstein-Barr virus DNA monitoring and imaging. Definitive patho-logical diagnosis and classification are essential for guiding treatment strategies, including reduction of immunosuppression and rituximab-based chemotherapy.