Kidney Week

Abstract: PUB531

Don't Get Burned Twice by the Same Post-transplant Lymphoproliferative Disorder (PTLD): A Case Highlighting the Progression and Advancement in PTLD Management in One Transplant Patient

Session Information

• Publication Only

Category: Transplantation

• 2102 Transplantation: Clinical

Authors

• Salam, Rania, Stony Brook University Hospital, Stony Brook, New York, United States

Rania Salam, MD

• Daccueil, Farah, Stony Brook University Hospital, Stony Brook, New York, United States

Farah Daccueil, MD

• Suh, Heesuck, Stony Brook University Hospital, Stony Brook, New York, United States

Heesuck Suh, MD

• Yip, Henry, Stony Brook University Hospital, Stony Brook, New York, United States

Henry Yip, MBBS

• Andrade, Katherine, Stony Brook University Hospital, Stony Brook, New York, United States

Katherine Andrade, MD

Introduction

PTLD, incidence is reported at 2-20% in solid organ transplant and throughout the decades carried a high risk of allograft lost as well as other hematologic and systemic complication. Management of immunosuppressant of transplanted patient with PTLD and management of PTLD itself has evolved over the years. Our case illustrated how far we have come in management of transplant patients with PLTD and the importance of surveillance.

Case Description

29 year old female with ESRD secondary to C1q nephropathy diagnosed in 1999 who received DDRT 2002 complicated by acute rejection in 2005 from immunosuppression reduction and eventual hold of immunosuppression for PTLD diagnosis in 2003 (mesenteric LN and appendix). She subsequently received another DDRT in 2006. She had a stable graft function and was followed closely by nephrology and oncology with regular PET scans. Eventually in 2023, had rising EBV titers, fatigue and high fever. She was referred to inpatient by nephrologist for further workup. Exam revealed fever 39.5 C, tachycardia, and normotensive. Labs marked for WBC 3.43, Hb 8.1, Ht 27.0 ESR 56, EBV plasma 44,900. CT scan showed large right-sided mediastinal mass measuring 7.8 cm. Bronchoscopy and mediastinal node biopsy, possible lymphoma. Cytology diagnosed PTLD Hodgkin type. Hematology recommended 6 cycles of A+AVD (Brentuximab vedotin, Doxorubicin, Vinblastine, Dacarbazine). Tacrolimus dose slight reduced with trough in range and MMF also reduced. Tumor burden significantly reduced and patient is reported to be doing well.

Discussion

PTLD often managed by reducing immunosuppression risking graft loss. However with advancement in treatment, patients are allowed to receive targeted treatment, maintain adequate transplant immunosuppression; with higher chances of graft preservation and improved quality of life. Our patient’s presentation showcases this progression, where her first transplant complicated by rejection after immunosuppression was reduced/held. Second transplant was preserved by timely diagnosis and targeted treatment of PTLD with chemotherapy.