A Case of Early Occurrence of Post-Transplant Lymphoproliferative Disorders in the Allograft after Kidney Transplantation.

Introduction: Post-transplant lymphoproliferative disorder (PTLD) is a serious complication after transplantation (Tx). The incidence pattern appears to be divided into two groups, depending on the onset time, as within 1 or 2 years after Tx and thereafter (early and late, respectively). We report very early onset and rapid progression of PTLD after kidney Tx.

Case presentation: A 49-year-old man with a 12-year history of hemodialysis underwent deceased donor kidney Tx from a 62-year-old male donor. Serological examination revealed negative antibodies in the recipient for viral capsid and Epstein-Barr virus (EBV)-associated nuclear antigens. Graft function recovery was delayed, possibly because of recurrent bacterial urinary tract infections, and the patient was weaned from dialysis on day 17. The protocol biopsy on day 37 showed moderate mononuclear cell infiltration in the interstitium with tubulitis. Urine output decreased, and the serum creatinine level rose abruptly at approximately the same time as we initiated steroid pulse therapy. The allograft biopsy was repeated on day 52 and demonstrated large atypical lymphoid cells in the parenchyma. Tumor cells were positive for CD20 and negative for CD3 with immunostaining and positive on EBV-encoded RNA in situ hybridization. The diagnosis was EBV-associated PTLD, histologically diffuse large B-cell lymphoma. Hemodialysis was resumed, and graftectomy was performed on day 58. At 12 months post-graftectomy, the patient was alive on dialysis, and imaging studies had revealed no extra-graft lesions.

Conclusion: Early onset and rapid progression of PTLD after Tx should be considered by transplant surgeons and physicians.