TREATMENT OF EPSTEIN-BARR VIRUS-INDUCED POSTTRANSPLANTATION LYMPHOPROLIFERATIVE DISORDER WITH FOSCARNET ALONE IN AN ADULT AFTER SIMULTANEOUS HEART AND RENAL TRANSPLANTATION

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Abstract
The kind and intensity of immunosuppression as well as Epstein-Barr virus, a transforming herpes virus that selectively infects B lymphocytes and causes infectious mononucleosis, have been implicated in the development of posttransplantation lymphproliferative disorders (PT-LPD), a life-threatening complication of solid organ transplantation. The morphologic spectrum of PT-LPD ranges from polymorphous hyperplasia to monomorphous B-non-Hodgkin lymphomas. Among different modalities of treatment, reduction of immunosuppression with or without coadministration of antiviral agents may result in PT-LPD regression especially in mononucleosis-like disease. Nonmononucleosis-like PT-LPD in a simultaneous heart and renal recipient was treated with Foscarnet, a potent inhibitor of different herpes viruses with a low profile of toxicity, although intensive immunosuppression therapy was maintained. A 4-week course of Foscarnet resulted in relapse-free complete remission (follow-up 10+ months). Thus, antiviral treatment with Foscarnet, may induce prolonged remission in non-mononucleosis-like PT-LPD without reduction of immunosuppression.