Two distinct patterns of post‐transplantation lymphoproliferative disorder (PTLD): Early and late onset

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Abstract
In our multi‐organ transplant program, we have noted two distinct patterns of PTLD: 1) potentially treatable PTLD appearing in the early post‐transplant period (≤ 90 days); and 2) fatal insidious PTLD of late onset. Between 1965 and 1990, 1662 transplants were performed and 16 patients developed PTLD. PTLD represented 18% of all malignancies during this time interval. Fourteen PTLDs occurred in kidney transplant recipients (KTxp) and 2 in liver transplant recipients (LTxp). Six of the 16 patients with PTLD presented within 90 d of transplantation (mean time 5 weeks) and 10 presented 4 months to 8 years after transplantation (mean time 152 wk). In the early‐onset PTLD group there was a disproportionate number of allografts well‐matched at DR loci. Four of 6 cases of early‐onset PTLD had evidence of recent Epstein‐Barr virus (EBV) infection. Five of these patients had also received OKT3. In the late‐onset group, 4 of 10 patients had received anti‐lymphocyte globulin (ALG). Three of 6 patients with early‐onset PTLD underwent transplant nephrectomy and survived, whereas all patients with late‐onset PTLD expired. Based on this small experience, it appears that early PTLD was associated with DR match, vigorous immunosuppression and EBV infection.