Retransplantation After Post-Transplant Lymphoproliferative Diseases (PTLD): When is it Safe?

Malignancy following organ transplantation is an increasingly important issue facing transplant clinicians, particularly as recipients survive longer (1,2). Among the more interesting of these malignancies are the post-transplant lymphoproliferative diseases (PTLD) because of the spectrum of diseases that occur, sometimes soon after transplantation and in other cases years post-transplant, and their unique relationship to the Epstein-Barr virus (EBV) (3). Studies have shown that there are four primary types of disease, the classification of which have important therapeutic and prognostic implications, and include: uncomplicated infectious mononucleosis; benign polyclonal B-cell hyperplasia without evidence of malignant transformation as shown by the absence of cytogenetic abnormalities or immunoglobulin gene rearrangements; the intermediate polymorphic B-cell lymphoma that is predominantly a polyclonal B-cell proliferation, but contains a subpopulation of malignantly transformed cells with clonal cytogenetic abnormalities and immunoglobulin gene rearrangements; and malignant monoclonal or oligoclonal B-cell lymphoma with clonal cytogenetic abnormalities and immunoglobulin gene rearrangements in a majority of cells (4).