Epstein‐Barr Virus‐Associated Posttransplant Lymphoproliferative Disorder of Donor Origin after Simultaneous Pancreas–Kidney Transplantation Limited to Pancreas Allograft: A Case Report

• Published in: American journal of transplantation Vol. 6; no. 10; pp. 2506 - 2511
• Main Authors: Rehbinder, B., Wullstein, Ch, Bechstein, W. O., Probst, M., Engels, K., Kriener, S., Döbert, N., Schwarz, W., Brixner, V., Steffan, D., Gauer, S., Geiger, H., Hauser, I. A.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.10.2006; Blackwell
• Subjects: Adult; Antibiotics. Antiinfectious agents. Antiparasitic agents; Antiviral agents; Biological and medical sciences; Biopsy; Burkitt Lymphoma - diagnosis; Burkitt Lymphoma - etiology; Burkitt Lymphoma - virology; B‐cell lymphoma; CD20; Diabetes Mellitus, Type 1 - surgery; Diagnosis, Differential; DNA, Viral - analysis; Epstein-Barr virus; Follow-Up Studies; ganciclovir; Hematologic and hematopoietic diseases; Herpesvirus 4, Human - genetics; Humans; Kidney Transplantation - adverse effects; Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis; Male; Medical sciences; microsatellite analysis; Middle Aged; Pancreas Transplantation - adverse effects; Pharmacology. Drug treatments; Positron-Emission Tomography; rituximab; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Tomography, X-Ray Computed; Transplantation, Homologous; transplantectomy; Origin; CD20; Acyclic nucleoside; Purine nucleoside; Concurrent; microsatellite analysis; transplantectomy; Transplantation; Epstein Barr virus; Monoclonal antibody; Homotransplantation; Kidney; Ganciclovir; Combined surgery; Posttransplant lymphoproliferative disorder; Microsatellite DNA; Lymphoproliferative syndrome; Anticytokine; Nucleoside analog; Graft; Antiviral; Pancreas; Gammaherpesvirinae; Human; Herpesviridae; Rituximab; Malignant hemopathy; B-Lymphocyte; Lymphoma; Infection; Virus; Case study; Immunomodulator; Treatment; Urinary system; Donor; Analysis; Viral disease; Immunosuppressive agent; Limit; B-cell lymphoma
• ISSN: 1600-6135; 1600-6143
• DOI: 10.1111/j.1600-6143.2006.01464.x

A 45‐year‐old man was admitted with fever and elevated pancreas enzymes 6 months after simultaneous pancreas–kidney transplantation (SPKT). Function of the allografts was normal. Bacterial and fungal infections were excluded, while Epstein‐Barr virus (EBV)‐polymerase chain reaction (PCR) was positive. However, screening for EBV‐associated lymphoma was negative. EBV infection did not respond to antiviral therapy. After an 18F‐Fluorodeoxyglucose positron emission tomography positive signal and an abnormal computed tomography scan of the pancreas transplant, a biopsy revealed a diffuse large monomorphic B‐cell lymphoma, which was confined to the grafted organ. Its origin was assigned to the donor by microsatellite analysis. Reduction of immunosuppression and immunotherapy with rituximab was unsuccessful. After 10 weeks, the patient developed an acute hemolytic uremic syndrome which required explantation of the allografts. Subsequent to the intervention, fever disappeared, EBV DNA became undetectable and lymphoma screening remained negative. In posttransplant lymphoproliferative disorder of donor origin after SPKT, transplantectomy may be a curative therapy. A B cell lymphoma of donor origin that developed in the pancreas six months after pancreas‐kidney transplantation was cured by removal of the transplanted organs.