A recent decrease in the time to development of monomorphous and polymorphous posttransplant lymphoproliferative disorder

We have noted a decrease in the time to development of posttransplant lymphoproliferative disorder (PTLD) over the last two and one-half years in our multiorgan transplant program. From February 1965 until Decem-ber 1990, 1622 transplants were performed including 1489 kidneys (KTxp), 87 livers (LTxp), and 46 pan-creata. Between February 1965 and July 1988 (group 1), there were 1260 transplants performed and nine cases of either monomorphous PTLD (M-PTLD, n=8) or polymorphous PTLD (P-PTLD, n=l) were diagnosed. The mean time to development of PTLD was 163±128 weeks, all after KTxp. Five of these nine patients re-ceived haploidentical living-related grafts. All patients had presented with advanced disease, none had trans-plant nephrectomy, and all died of their disease. Be-tween July 1988 and December 1990 (group 2), 362 transplants were performed, and four cases of M-PTLD and three cases of P-PTLD were recognized. Of the seven cases of PTLD in group 2, six developed within 90 days posttransplant (early PTLD). The mean time to development of PTLD was 11±16 weeks. This was sig-nificantly earlier than group 1 (P<.01). Four of the five cases after KTxp had a 1 or 2 DR-matched donor. Five of these seven patients had serological evidence of recent Epstein-Barr Virus infection, and four of these five had received OKT3 and then developed early PTLD. In group 2, three patients are alive 7-15 months after KTxp nephrectomy, the remaining four have died. We hypothesize that risk factors for the development of PTLD may include heavy immunosuppression, includ-ing the use of OKT3, good DR matching, and active EBV infection. Treatment should include graft removal, if applicable, and reduction or cessation of immuno-suppression.