Two distinct patterns of post-transplantation lymphoproliferative disorder (PTLD): Early and late onset

In our multi-organ transplant program, we have noted two distinct patterns of PTLD: 1) potentially treatable PTLD appearing in the early post-transplant period (≤90 days); and 2) fatal insidious PTLD of late onset. Between 1965 and 1990, 1662 transplants were performed and 16 patients developed PTLD. PTLD represented 18% of all malignancies during this time interval. Fourteen PTLDs occurred in kidney transplant recipients (KTxp) and 2 in liver transplant recipients (LTxp). Six of the 16 patients with PTLD presented within 90d of transplantation (mean time 5 weeks) and 10 presented 4 months to 8 years after transplantation (mean time 152 wk). In the early-onset PTLD group there was a disproportionate number of allografts well-matched at DR loci. Four of 6 cases of early-onset PTLD had evidence of recent Epstein-Barr virus (EBV) infection. Five of these patients had also received OKT3. In the late-onset group, 4 of 10 patients had received anti-lymphocyte globulin (ALG). Three of 6 patients with early-onset PTLD underwent transplant nephrectomy and survived, whereas all patients with late-onset PTLD expired. Based on this small experience, it appears that early PTLD was associated with DR match, vigorous immunosuppression and EBV infection.