Lymphoproliferative disorders in renal transplant patients in Japan

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Abstract
Post‐transplantation lymphoproliferative disorders (PT‐LPD) are characterized by a clinically and morphologically heterogeneous group of lymphoid proliferation occurring after organ or bone marrow transplantation. The immunodeficient state provides a basis for lymphomagenesis probably through activation of oncogenic viruses. Twenty‐four patients in whom PT‐LPD developed after renal transplantation in Japan were analyzed. They received hemodialysis for 4 to 226 (median 13) months before transplantation. In situ hybridization was performed to detect Epstein‐Barr virus (EBV). Polymerase chain reaction and Southern hybridization with primers in the tax and pol regions of human T‐cell leukemia virus type I (HTLV‐1) were performed on DNA extracted from paraffin‐embedded specimens. Immunohistochemical analysis revealed that 12 cases were B‐cell type, 10 cases (42%) T‐cell type and 2 NK‐cell type. Five of the T‐cell cases were classified as adult T‐cell lymphoma with proven HTLV‐1 genome in the tumor and seropositivity for the virus. These cases were classified as adult T‐cell lymphoma (ALT). More than 80% of B‐cell, 30% of T‐cell and both NK/T‐cell lymphomas were EBV‐positive. Co‐infection of EBV and HTLV‐1 was found in 2 cases with ATL. These findings showed that ATL is common among Japanese renal transplant patients, which might be due to transmission of HTLV‐1 via blood transfusion during hemodialysis.

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