Epstein-Barr Virus-Associated Posttransplant Lymphoproliferative Disorder of Donor Origin after Simultaneous Pancreas–Kidney Transplantation Limited to Pancreas Allograft: A Case Report

Abstract

A 45-year-old man was admitted with fever and elevated pancreas enzymes 6 months after simultaneous pancreas-kidney transplantation (SPKT). Function of the allografts was normal. Bacterial and fungal infections were excluded, while Epstein-Barr virus (EBV)-polymerase chain reaction (PCR) was positive. However, screening for EBV-associated lymphoma was negative. EBV infection did not respond to antiviral therapy. After an 18F-Fluorodeoxyglucose positron emission tomography positive signal and an abnormal computed tomography scan of the pancreas transplant, a biopsy revealed a diffuse large monomorphic B-cell lymphoma, which was confined to the grafted organ. Its origin was assigned to the donor by microsatellite analysis. Reduction of immunosuppression and immunotherapy with rituximab was unsuccessful. After 10 weeks, the patient developed an acute hemolytic uremic syndrome which required explantation of the allografts. Subsequent to the intervention, fever disappeared, EBV DNA became undetectable and lymphoma screening remained negative. In posttransplant lymphoproliferative disorder of donor origin after SPKT, transplantectomy may be a curative therapy.

Post-transplant Lymphoproliferative Disorders: Determination of Donor/Recipient Origin in a Large Cohort of Kidney Recipients

“…We showed that the great majority of donor PTLDs arose in the graft itself (14/16). In the literature, 18 donor PTLDs were localized in or near the graft (10–31,42). Moreover, in these published reports of donor lymphomas, only one tumor was known to disseminate outside the graft (32).…”

“…From the histological point of view, a spectrum of lesions ranging from infectious mononucleosis to a malignant lymphoma comprises the clinical entity known as PTLD (9). A number of small‐scale studies and case reports have shown that PTLDs localized in the graft organ itself may originate from donor cells without being donor transmitted (10–31). Nevertheless, contrary to bone marrow transplant where PTLDs typically derive from donor lymphocytes, the majority of PTLDs that develop after organ transplantation derive from recipient lymphocytes (32–34).…”

Late Onset Graft Plasmacytoma-Like PTLD Presenting as Acute Hyperglycemia in a Kidney-Pancreas Transplant Recipient

“…Allograft involvement as a manifestation of plasmacytoma-like PTLD has been previously described in SOT, infiltrating liver [5, 12], kidney [13], and heart [14] transplants. Pancreas graft infiltration by an EBV-positive B-cell lymphoma was described by Rehbinder et al [15]. To our knowledge, this is the first report of an isolated pancreas allograft plasmacytoma-like PTLD.…”

Posttransplant Lymphoproliferative Disorder Presenting as a Small Bowel Obstruction in a Patient with Pancreas Transplantation Alone

“…As demonstrated across other solid organ transplants, disseminated disease carries a poorer prognosis than lymph node disease alone (3). Two case studies reported PTLD limited to the pancreatic allograft after SPK transplant (9,10). In each case, the recipient had multiple admissions and a presentation that was initially thought to be graft pancreatitis.…”