China
Africa
Explore chapters and articles related to this topic
Transplant Surgery
Published in Tjun Tang, Elizabeth O'Riordan, Stewart Walsh, Cracking the Intercollegiate General Surgery FRCS Viva, 2020
David van Dellen, Zia Moinuddin, Hussein Khambalia, Brian KP Goh
How will you manage this patient?The differential diagnosis is likely to be infective causes (particularly TB with the symptom and patient history) or potentially post-transplant lymphoproliferative disorder (PTLD).Take a full history and do a systematic examination, particularly focusing on respiratory examination for potential TB and an examination for potential associated generalised lymphadenopathy or hepatosplenomegaly.Get a full set of screening tests, including graft function, and routine blood tests including LDH and virology (CMV, BK but particularly EBV serology)EBV infection is a common predisposing factor for PTLD development, especially in young transplant recipients.Request a chest x-ray.A lymph node biopsy can be used for formal histological diagnosis.
Answers
Published in John D Firth, Professor Ian Gilmore, MRCP Part 2 Self-Assessment, 2018
John D Firth, Professor Ian Gilmore
The case would be typical of post transplant lymphoproliferative disorder (PTLD), the likelihood of which is associated with the degree of previous immunosuppression. This man was exposed to potent anti-rejection therapy in the form of anti-thymocyte globulin (ATG) in addition to his baseline immunosuppressive drugs. PTLD is often driven by Epstein–Barr virus and can be treated by graded reduction in immunosuppression. It would be unusual for CMV disease to present at this time: it usually occurs much earlier in the post transplant period. Chronic rejection does not cause systemic symptoms and signs such as those described here.
Transplant Surgery
Published in Kaji Sritharan, Samia Ijaz, Neil Russell, Tim Allen-Mersh, 300 Essentials SBAs in Surgery, 2017
Kaji Sritharan, Samia Ijaz, Neil Russell, Tim Allen-Mersh
A 74-year-old man presents to the transplant clinic 10 years after a kidney transplant feeling generally unwell and having noticed swelling in his groins. He is still taking cyclosporine, azathioprine and prednisolone. You examine him and find him to have bilaterally palpable groin lymphadenopathy. You cannot palpate any other enlarged nodes. You suspect he may be suffering from: Chronic rejectionPost-transplant lymphoproliferative disorder (PTLD)Acute rejectionA systemic bacterial infectionCMV disease
Pharmacotherapeutic options for the prevention of kidney transplant rejection: the evidence to date
Published in Expert Opinion on Pharmacotherapy, 2022
Goce Spasovski, Lada Trajceska, Irena Rambabova-Bushljetik
In the initial Phase II study, belatacept was found to be noninferior to CsA in prevention of AR at 6 months. The incidence of AR was comparable between the intensive, less-intensive belatacept and CsA treatment. Patients with intensive regimens developed post-transplant lymphoproliferative disorder (PTLD) more frequently compared to CsA treatment. The GFR at 12 months was significantly higher with more and less-intensive belatacept groups compared with cyclosporine (66.3, 62.1, and 53.5 ml/min/1.73 m2), respectively. Chronic allograft nephropathy (CAN) was less frequently found in patients treated with either belatacept regimens compared to the CsA [60]. During the 5-year FU, none of the belatacept patients developed PTLD, in contrast to one patient in the CsA group diagnosed with PTLD at 4 years post-transplantation [61].
Prevention of viral infections in solid organ transplant recipients in the era of COVID-19: a narrative review
Published in Expert Review of Anti-infective Therapy, 2022
Paraskevas Filippidis, Julien Vionnet, Oriol Manuel, Matteo Mombelli
EBV belongs to the Gammaherpesvirinae subfamily and establishes lifelong latency in B lymphocytes. Primary infection generally occur during childhood and adolescence, with seropositivity rates up to 90–95% at the late adulthood. In SOT recipients, the main EBV-related complication is post-transplant lymphoproliferative disorder (PTLD), one of the most frequent post-transplant malignancies caused by B-cell proliferation due to impaired T-cell control. Incidence of EBV-associated PTLD ranges from 1% to 30%, with EBV mismatched serostatus (D+/R-) and the use of lymphocyte-depleting antibodies as the major risk factors [129]. EBV-associated PTLD is particularly common during the first post-transplant year, while the incidence of EBV-negative PTLD increases later after transplantation [130].
Lymphomatoid Granulomatosis in a 14-Year-Old Boy with Trisomy 21 and History of B-Lymphoblastic Leukemia/Lymphoma
Published in Fetal and Pediatric Pathology, 2018
Anna Paulina Matynia, Sherrie L. Perkins, David Li
An infectious etiology should be excluded by cultures and/or special stains in all cases. Inflammatory disorders such as Wegener granulomatosis can enter the differential diagnosis of low grade LYG due to their cellular perivascular infiltrates and necrosis. The presence of true granulomas, multinucleated giant cells, neutrophils and eosinophils support that diagnosis and argue against LYG; however, atypical cells, as seen in our case, are not a part of the infiltrate present in cases of Wegener granulomatosis. Other EBV-associated lymphoproliferative disorders such as lymphoid hyperplasia could also be considered in cases presenting with low grade findings. Notably, low grade EBV associated lesions are not associated with angiodestructive and/or angioinvasive features, present in our case. Other types of EBV associated lymphomas should also be excluded prior to making the diagnosis of LYG. Extranodal NK/T-cell lymphoma, nasal type, may present with angiodestructive growth pattern, and is associated with EBV. The large atypical cells in our case expressed B-cell markers (CD19 and CD20), which help exclude that entity. Classical Hodgkin lymphoma can be considered, especially in the pediatric population, but in our case it was excluded based on morphologic and immunophenotypic finding. In patients with a history of solid organ, bone marrow or stem cell transplant, post-transplant lymphoproliferative disorder (PTLD) would be considered; however, our patient did not have a history of a transplant. Additionally some argue that LYG should not be diagnosed in that clinical setting (4).