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Epstein-Barr virus-negative post-transplant lymphoproliferative disorders: a distinct entity?
B P Nelson1, M A Nalesnik, D W Bahler
1Department of Pathology, University of Pittsburgh School of Medicine, PA, USA.
The American Journal of Surgical Pathology
|March 15, 2000
Summary
Epstein-Barr virus (EBV)-negative post-transplant lymphoproliferative disorders (PTLDs) are distinct from EBV-positive PTLDs, appearing later post-transplant and often presenting as monomorphic PTLDs. Some EBV-negative PTLDs respond to reduced immunosuppression, challenging EBV status as an absolute diagnostic criterion.
Area of Science:
- Transplant Medicine
- Oncology
- Virology
Background:
- Post-transplant lymphoproliferative disorders (PTLDs) are serious complications following organ transplantation.
- While often associated with Epstein-Barr virus (EBV), the characteristics and significance of EBV-negative PTLDs remain unclear.
Purpose of the Study:
- To investigate the distinct features of EBV-negative PTLDs compared to EBV-positive PTLDs.
- To determine if EBV-negative PTLDs represent a unique clinical and pathological entity.
Main Methods:
- Determined EBV status in 133 PTLDs from 80 patients using EBER in situ hybridization and Southern blot analysis.
- Reviewed and compared morphologic, immunophenotypic, genotypic, and clinical features of EBV-negative and EBV-positive PTLDs.
Main Results:
- Twenty-one percent of patients had at least one EBV-negative PTLD, occurring later post-transplant (median 50 months vs. 10 months).
- EBV-negative PTLDs were more frequently of the monomorphic type (M-PTLD) (67% vs. 42%).
- Increased incidence of EBV-negative PTLDs observed after 1991 (23% vs. 2%).
Conclusions:
- EBV-negative PTLDs exhibit distinct features, including later onset and a higher prevalence of M-PTLD.
- Some EBV-negative PTLDs respond to immunosuppression reduction, suggesting EBV status is not the sole diagnostic determinant.
- Further research is needed to fully elucidate the pathogenesis and optimal management of EBV-negative PTLDs.