Posttransplantation lymphoproliferative disorder: changing manifestations of disease in a renal transplant population.

Objective: To review the changing manifestations of PTLD in patients with renal transplants.

Methods: Review of 1954 records of the renal transplantation clinic from 1971 to 1993 produced 17 patients with the diagnosis of PTLD.

Results: With changes in immunosuppression, the sites of involvement of PTLD have changed. Central nervous system involvement was the predominant site of disease prior to the use of cyclosporine. With the institution of cyclosporine, thoracic, and abdominal presentations became more common. PTLD isolated to the renal transplant is a new manifestation of disease that may be a result of immunosuppression with OKT3. Monomorphous PTLD was associated with a 78% PTLD related mortality. Polymorphous PTLD had a 0% PTLD related mortality. In patients with cross-sectional imaging abnormalities, PTLD presented as solitary or multiple masses in 78%. This is the finding most suggestive of PTLD in a transplant population.

Conclusion: Posttransplantation lymphoproliferative disorder is a heterogeneous grouping of lymphoid proliferation with variable clinical and radiographic manifestations. An understanding of the range of manifestations may lead to improved diagnosis of this unusual disorder.