The Epstein-Barr virus in the pathogenesis of posttransplant lymphoproliferative disorders. Clinical, pathologic, and virologic correlation.

摘要: Twelve renal transplant patients with lymphoproliferative disorders (LPDs) were studied. Two clinical patterns identified: (1) Young present an infectious mononucleosis-like illness fever, sore throat, and lymphadenopathy soon after transplantation or antirejection therapy. Many organs are ultimately involved, the course is one of a rapidly fatal LPD. (2) Older longer time symptoms solid tumors involving central nervous system, oropharynx, liver, small bowel. The slower, but it progressive fatal. Morphologically these LPDs can all be classified as polymorphic diffuse B-cell hyperplasia (PDBH) lymphoma (PBL). Cell marker studies in four demonstrated polyclonal proliferation. Transition from proliferation to monoclonal tumor may occur. Epstein-Barr virus (EBV) specific antibody titers, anticomplement immunofluorescence staining for presence nuclear antigen (EBNA), EBV complementary ribonucleic acid (cRNA)/deoxyribonucleic (DNA) hybridization vDNA/DNA reassociation analysis implicate probable etiologic agent disorders. Successful management lethal depend on discontinuation immunosuppression removal allograft. Antiviral therapy, however, prove useful.