Monoclonality of Lymphoproliferative Lesions in Cardiac-Transplant Recipients

Whether lymphoproliferative disorders arising in immunosuppressed recipients of organ transplants are primarily neoplastic or hyperplastic in nature is a matter of controversy. Reports of polyclonal B-cell proliferations in these lesions suggest the presence of hyperplasia, but these disorders resemble lymphoma histologically and are clinically aggressive and often rapidly fatal, as expected of a malignant neoplastic disease. We examined tissue specimens from 10 cases of lymphoproliferative disease that occurred in immunosuppressed recipients of cardiac transplants. Specimens from nine of these patients lacked cellular immunoglobulin; however, analysis of DNA extracted from these tissues revealed that each lesion contained large numbers of cells possessing uniform, clonal rearrangements of immunoglobulin-gene DNA. Therefore, when first seen clinically these proliferations contained a notable monoclonal-cell population typical of conventional B-cell lymphomas that are not associated with immunosuppression. We therefore suggest that lymphoproliferative disorders in recipients of cardiac transplants are neoplastic at the earliest stages of detectable disease.