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Epidemiology, clinical manifestations, and diagnosis of post-transplant lymphoproliferative disorders

Jonathan W Friedberg, MD
Jon C Aster, MD
Section Editors
Arnold S Freedman, MD
Daniel C Brennan, MD, FACP
Deputy Editors
Alan G Rosmarin, MD
Albert Q Lam, MD


Post-transplant lymphoproliferative disorders (PTLD) are lymphoid and/or plasmacytic proliferations that occur in the setting of solid organ or allogeneic hematopoietic cell transplantation as a result of immunosuppression. They are among the most serious and potentially fatal complications of transplantation. While the majority appears to be related to the presence of Epstein-Barr virus (EBV), EBV-negative disease does occur. Three general types of PTLD have been described in transplant recipients:

Early lesions (ie, plasmacytic hyperplasia and infectious mononucleosis-like PTLD) – This presents as an infectious mononucleosis-type acute illness characterized by polyclonal B cell proliferation with no evidence to suggest malignant transformation.

Polymorphic PTLD – Polymorphic PTLD are polyclonal or monoclonal lymphoid infiltrates that demonstrate evidence of malignant transformation but do not meet all of the criteria for one of the B cell or T/NK cell lymphomas recognized in immunocompetent patients.

Monomorphic PTLD – Monomorphic PTLD are monoclonal lymphoid proliferations that meet the criteria for one of the B cell or T/NK cell lymphomas recognized in immunocompetent patients.

These conditions lie along a continuum of disease and are categorized by the 2008 World Health Organization classification system as PTLD [1]. Of importance, small B cell lymphoid neoplasms (eg, follicular lymphomas, small lymphocytic lymphoma) and marginal zone (MALT) lymphomas arising in the post-transplant setting are not considered PTLD.

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Literature review current through: Nov 2017. | This topic last updated: Nov 17, 2017.
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