Diagnosis, prevention, and management of Epstein-Barr virus-associated posttransplant lymphoproliferative disorders in organ transplant recipients:

Strategies for Epstein–Barr virus monitoring, detection and therapy in post-transplant lymphoproliferative disorder

Epstein–Barr virus (EBV) is a significant cause of morbidity and mortality in solid-organ transplant (SOT) recipients. The most serious complication of EBV infection in this population is post-transplant lymphoproliferative disorder (PTLD). EBV-viral load monitoring can be used to predict those SOT patients at high risk of PTLD, particularly those who are EBV seronegative prior to transplant. Surveillance EBV-load monitoring to inform pre-emptive reduction of immunosuppression has contributed to the decrease in the incidence of PTLD in SOT recipients. The use of the anti-CD20 antibody, rituximab, as a therapeutic agent is increasing, with anecdotal reports of positive outcomes. However, experience to date suggests that the use of this agent may not prevent recurrence of the tumor or improve cell-mediated immune responses to EBV. Future investigation of EBV-specific T-cell responses as an adjunct to monitoring, and the adoptive transfer of EBV-specific cytotoxic T lymphocytes appear likely in future attempts as a means to limit the consequences of EBV infection in the SOT population.

Monomorphic Epstein-Barr virus (EBV)-associated large B-cell posttransplant lymphoproliferative disorder presenting as a tongue ulcer in a pancreatic transplant patient

Posttransplant lymphoproliferative disorders are a group of lymphoid proliferations and lymphomas that develop as a consequence of immunosuppression in recipients of solid organ or bone marrow allografts. We describe an unusual oral presentation of posttransplant Epstein-Barr virus-associated diffuse large B-cell lymphoma in a 45-year-old woman after pancreatic transplant.