Lymphoproliferative disorders after renal transplantation: role of medical imaging

Abstract

Post-transplantation lymphoproliferative disorders (PTLD) are a complication of immunosuppressed transplant recipients, and their incidence is reported to be 20-120 times greater than the rate in the general population. After kidney transplantation, PTLD more likely arise within the renal transplant fossa. Radiological patterns of these forms are presented and discussed, according to a review of the literature, and illustrated by cases from our institution. Ultrasound plays an essential role in the early diagnosis of PTLD by detecting a urinary obstruction associated with adenopathy or an ill-defined mass not previously seen. However, in the case of an inconclusive US examination, CT or MRI should be performed to confirm the presence of a mass. Both techniques are useful in evaluating the extension of the process within the transplantation fossa; MRI seems more accurate and can be used for the follow-up, especially after reduction in immunosuppressive therapy without transplant removal.

Presentation and early detection of post-transplant lymphoproliferative disorder after solid organ transplantation

“…This is especially true for allograft involvement of PTLD. Kidney transplant recipients with allograft involvement of PTLD often present with renal dysfunction, hydronephrosis because of ureteral obstruction and fever [63,79]. An ultrasound scan may then quickly reveal adenopathy or an ill‐defined mass [79]).…”

“…Kidney transplant recipients with allograft involvement of PTLD often present with renal dysfunction, hydronephrosis because of ureteral obstruction and fever [63,79]. An ultrasound scan may then quickly reveal adenopathy or an ill‐defined mass [79]). Lung transplant recipients may present with organ dysfunction after which a plain chest X ray or computerized tomography (CT) scanning of the thorax may be helpful in the diagnostic process [62,80,81].…”

Ultrasound detection of non‐Hodgkin's lymphoma in three cynomolgus monkeys after renal transplantation and cyclosporine immunosuppression

“…Sixty-nine percent of NHLs are extranodal, can be detected in the grafts and in patients treated with cyclosporine; the most common site is the thoracoabdominal region [4,6,9,11]. Ultrasonography is a frequently used non-invasive imaging method for the detection of abdominal lymph node enlargement in humans and plays an important role in the detection of PTLD [5,7,9,10,13]. In NHL, the abdominal lymph nodes, especially the mesenteric lymph nodes, are most commonly enlarged and the tendency for extranodal involvement (GI-tract, spleen and urinary tract) is high and may also be present in allografts [4,13].…”

Risk factors, diagnosis, and management of posttransplant lymphoproliferative disorder: improving patient outcomes with a multidisciplinary treatment approach

“…[55][56][57] For example, kidney transplant recipients with allograft involvement often present with renal dysfunction or signs of ureteral obstruction (ie, hydronephrosis) and fever. 56,58 Further signs of PTLD depend on the involved organs and therefore can be highly variable. Signs of PTLD can range from isolated hepatitis, lymphoid interstitial pneumonitis to infectious mononucleosis-like syndrome with fever, peripheral lymphadenopathy, and hepatitis.…”