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Post-transplant lymphoproliferative disorder presenting as a tumor adjacent to the renal allograft: A case report and review of the literature.

Gao C, Peng L, Peng F, Tuo T, Li D - Oncol Lett (2014)

Bottom Line: Post-transplant lymphoproliferative disorder (PTLD) is a potentially fatal complication of solid organ transplantation.The disorder manifested as a tumor adjacent to the lower pole of the renal allograft and resulted in urinary obstruction.Durable complete remission was achieved as a result of surgical resection followed by a reduction in immunosuppression and low-dose rituximab-based chemotherapy, indicating that this therapeutic strategy may be safe and effective for the treatment of specific cases of localized and resectable PTLD.

View Article: PubMed Central - PubMed

Affiliation: Department of Urological Organ Transplantation, Second Xiangya Hospital, Central South University, Changsha, Hunan 41011, P.R. China.

ABSTRACT
Post-transplant lymphoproliferative disorder (PTLD) is a potentially fatal complication of solid organ transplantation. The current report presents the case of a 42-year-old male who developed PTLD within the first year following renal transplantation. The disorder manifested as a tumor adjacent to the lower pole of the renal allograft and resulted in urinary obstruction. Durable complete remission was achieved as a result of surgical resection followed by a reduction in immunosuppression and low-dose rituximab-based chemotherapy, indicating that this therapeutic strategy may be safe and effective for the treatment of specific cases of localized and resectable PTLD.

No MeSH data available.


Related in: MedlinePlus

(A) Abdominal computed tomography showing a solid mass adjacent to the renal allograft. (B) Abdominal computed tomography with coronal multiplanar reformation showing a solid mass adjacent to the lower pole of the renal allograft and hydronephrosis. The arrow indicates the solid mass.
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f1-ol-08-06-2607: (A) Abdominal computed tomography showing a solid mass adjacent to the renal allograft. (B) Abdominal computed tomography with coronal multiplanar reformation showing a solid mass adjacent to the lower pole of the renal allograft and hydronephrosis. The arrow indicates the solid mass.

Mentions: In March 2012, a 42-year-old male exhibiting end-stage renal disease secondary to hypertension received a kidney transplant at the Second Xiangya Hospital of Central South University (Changsha, China). The donor was a 27-year-old male who had succumbed to cardiac failure caused by craniocerebral trauma. The human leukocyte antigen (HLA) type of the donor and the recipient were A11/A2-B58/B13-DR4/DR53, DR9/DR53 and A2/A2-B13/B61-DR15/DR51, DR9/DR53, respectively. The recipient was EBV seronegative, however, the donor’s EBV serologic status was unknown, as EBV serologic status was not tested routinely at the time of donation. Furthermore, the donor and recipient were seronegative for cytomegalovirus, and the Hepatitis B and C viruses. There were no complications during surgical follow-up. The patient’s post-transplant immunosuppressive regimen included: Intravenous methylprednisolone (dose during surgery, 0.5 g; dose for the first three days following surgery, 0.5 g/day); followed by cyclosporine (CsA; initial dose, 6 mg/kg/day; trough concentration was adjusted to 220–250 ng/ml 0–6 months following transplantation and 180–220 ng/ml over the next 6–12 months); oral mycophenolate mofetil (MMF; dose, 0.75 g per 12 h; gradually reduced to 0.5 g per 12 h for long-term maintenance immunosuppression); and prednisolone (initial dose, 80 mg/day; gradually reduced to 10 mg/day over the next 6 months for long-term maintenance immunosuppression). Good renal allograft function was observed immediately following surgery. On the twelfth postoperative day, the patient exhibited a serum creatinine level of 133 μmol/l (normal range, 44–133 μmol/l) and was discharged. The allograft function remained normal during the out-patient follow-up, however, seven months post-transplantation, the patient developed a fever, oliguria and an elevated serum creatinine level (410.7 μmol/l). Sonography and computed tomography revealed a solid mass adjacent to the renal allograft (Fig. 1A) and computed tomography with coronal multiplanar reformation revealed a solid mass (size, 6×4×8 cm) in the lower pole of the allograft and hydronephrosis (Fig. 1B). Percutaneous nephrostomy tubes were inserted, resulting in a decline in the serum creatinine level. Subsequently, surgical resection was performed and a tumor with a poorly defined margin, located adjacent and in close proximity to the lower pole of the allograft, was removed. Postoperatively, serum creatinine returned to within the normal range following treatment of the urinary obstruction. Intra- and postoperative histopathological assessments determined a diagnosis of polymorphic PTLD with positive stains for cluster of differentiation (CD)20, CD79a, CD3 and EBV-encoded RNA (Fig. 2). The proliferation index of Ki-67 was 40%. Upon diagnosis, the blood EBV DNA level was 1.3×104 copies/ml, and the lactate dehydrogenase level (normal range, 135–215 U/l) and bone marrow biopsy were normal. Therefore, MMF therapy was discontinued and CsA was replaced with Rapamune (Wyeth Pharmaceuticals, Dallas, TX, USA) (trough concentration adjusted to 6–8 ng/ml) to reduce the level of immunosuppression. Furthermore, four cycles of adjuvant low-dose chemotherapy were administered, including rituximab (300 mg/m2), cyclophosphamide (500 mg/m2), vincristine (1.2 mg/m2) and prednisolone (50 mg/m2). The patient’s blood was negative for EBV DNA following the first cycle of chemotherapy. During the 16-month follow-up after resection, the patient remained in remission, neither EBV viremia nor PTLD recurred and renal allograft function was preserved. Outpatient follow-up is ongoing to determine the long-term outcome of the treatment strategy.


Post-transplant lymphoproliferative disorder presenting as a tumor adjacent to the renal allograft: A case report and review of the literature.

Gao C, Peng L, Peng F, Tuo T, Li D - Oncol Lett (2014)

(A) Abdominal computed tomography showing a solid mass adjacent to the renal allograft. (B) Abdominal computed tomography with coronal multiplanar reformation showing a solid mass adjacent to the lower pole of the renal allograft and hydronephrosis. The arrow indicates the solid mass.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4214511&req=5

f1-ol-08-06-2607: (A) Abdominal computed tomography showing a solid mass adjacent to the renal allograft. (B) Abdominal computed tomography with coronal multiplanar reformation showing a solid mass adjacent to the lower pole of the renal allograft and hydronephrosis. The arrow indicates the solid mass.
Mentions: In March 2012, a 42-year-old male exhibiting end-stage renal disease secondary to hypertension received a kidney transplant at the Second Xiangya Hospital of Central South University (Changsha, China). The donor was a 27-year-old male who had succumbed to cardiac failure caused by craniocerebral trauma. The human leukocyte antigen (HLA) type of the donor and the recipient were A11/A2-B58/B13-DR4/DR53, DR9/DR53 and A2/A2-B13/B61-DR15/DR51, DR9/DR53, respectively. The recipient was EBV seronegative, however, the donor’s EBV serologic status was unknown, as EBV serologic status was not tested routinely at the time of donation. Furthermore, the donor and recipient were seronegative for cytomegalovirus, and the Hepatitis B and C viruses. There were no complications during surgical follow-up. The patient’s post-transplant immunosuppressive regimen included: Intravenous methylprednisolone (dose during surgery, 0.5 g; dose for the first three days following surgery, 0.5 g/day); followed by cyclosporine (CsA; initial dose, 6 mg/kg/day; trough concentration was adjusted to 220–250 ng/ml 0–6 months following transplantation and 180–220 ng/ml over the next 6–12 months); oral mycophenolate mofetil (MMF; dose, 0.75 g per 12 h; gradually reduced to 0.5 g per 12 h for long-term maintenance immunosuppression); and prednisolone (initial dose, 80 mg/day; gradually reduced to 10 mg/day over the next 6 months for long-term maintenance immunosuppression). Good renal allograft function was observed immediately following surgery. On the twelfth postoperative day, the patient exhibited a serum creatinine level of 133 μmol/l (normal range, 44–133 μmol/l) and was discharged. The allograft function remained normal during the out-patient follow-up, however, seven months post-transplantation, the patient developed a fever, oliguria and an elevated serum creatinine level (410.7 μmol/l). Sonography and computed tomography revealed a solid mass adjacent to the renal allograft (Fig. 1A) and computed tomography with coronal multiplanar reformation revealed a solid mass (size, 6×4×8 cm) in the lower pole of the allograft and hydronephrosis (Fig. 1B). Percutaneous nephrostomy tubes were inserted, resulting in a decline in the serum creatinine level. Subsequently, surgical resection was performed and a tumor with a poorly defined margin, located adjacent and in close proximity to the lower pole of the allograft, was removed. Postoperatively, serum creatinine returned to within the normal range following treatment of the urinary obstruction. Intra- and postoperative histopathological assessments determined a diagnosis of polymorphic PTLD with positive stains for cluster of differentiation (CD)20, CD79a, CD3 and EBV-encoded RNA (Fig. 2). The proliferation index of Ki-67 was 40%. Upon diagnosis, the blood EBV DNA level was 1.3×104 copies/ml, and the lactate dehydrogenase level (normal range, 135–215 U/l) and bone marrow biopsy were normal. Therefore, MMF therapy was discontinued and CsA was replaced with Rapamune (Wyeth Pharmaceuticals, Dallas, TX, USA) (trough concentration adjusted to 6–8 ng/ml) to reduce the level of immunosuppression. Furthermore, four cycles of adjuvant low-dose chemotherapy were administered, including rituximab (300 mg/m2), cyclophosphamide (500 mg/m2), vincristine (1.2 mg/m2) and prednisolone (50 mg/m2). The patient’s blood was negative for EBV DNA following the first cycle of chemotherapy. During the 16-month follow-up after resection, the patient remained in remission, neither EBV viremia nor PTLD recurred and renal allograft function was preserved. Outpatient follow-up is ongoing to determine the long-term outcome of the treatment strategy.

Bottom Line: Post-transplant lymphoproliferative disorder (PTLD) is a potentially fatal complication of solid organ transplantation.The disorder manifested as a tumor adjacent to the lower pole of the renal allograft and resulted in urinary obstruction.Durable complete remission was achieved as a result of surgical resection followed by a reduction in immunosuppression and low-dose rituximab-based chemotherapy, indicating that this therapeutic strategy may be safe and effective for the treatment of specific cases of localized and resectable PTLD.

View Article: PubMed Central - PubMed

Affiliation: Department of Urological Organ Transplantation, Second Xiangya Hospital, Central South University, Changsha, Hunan 41011, P.R. China.

ABSTRACT
Post-transplant lymphoproliferative disorder (PTLD) is a potentially fatal complication of solid organ transplantation. The current report presents the case of a 42-year-old male who developed PTLD within the first year following renal transplantation. The disorder manifested as a tumor adjacent to the lower pole of the renal allograft and resulted in urinary obstruction. Durable complete remission was achieved as a result of surgical resection followed by a reduction in immunosuppression and low-dose rituximab-based chemotherapy, indicating that this therapeutic strategy may be safe and effective for the treatment of specific cases of localized and resectable PTLD.

No MeSH data available.


Related in: MedlinePlus