Posttransplantation lymphoproliferative disorder: endoscopic findings

Area of Science:

• Gastroenterology
• Transplant Surgery
• Pediatric Oncology

Background:

• Posttransplantation lymphoproliferative disorder (PTLD) presents with nonspecific symptoms after solid organ transplantation.
• Gastrointestinal involvement is common, offering an endoscopic diagnostic opportunity.
• This study describes characteristic endoscopic findings in pediatric liver transplant recipients with suspected PTLD.

Purpose of the Study:

• To identify characteristic endoscopic findings of PTLD in pediatric liver transplant recipients.
• To evaluate the utility of endoscopy in diagnosing gastrointestinal PTLD.
• To correlate endoscopic findings with Epstein-Barr virus (EBV) status.

Main Methods:

• Endoscopic evaluation was performed in 14 pediatric liver transplant patients presenting with gastrointestinal symptoms.
• Biopsy specimens were obtained from abnormal findings and standard gastrointestinal sites.
• Specimens were stained for Epstein-Barr virus latent membrane protein and cytomegalovirus.

Main Results:

• Six patients exhibited characteristic raised, rubbery, erythematous lesions with central ulceration (5-15 mm).
• Microscopic evaluation showed monotonous lymphocyte proliferation, with all positive EBV stains.
• Biopsies from patients without characteristic lesions were negative for PTLD.

Conclusions:

• Panendoscopy is a valuable tool for diagnosing and managing gastrointestinal PTLD.
• Endoscopy offers rapid diagnosis when characteristic lesions are present and provides tissue for classification.
• Pediatric liver transplant patients with unexplained GI symptoms warrant panendoscopy for suspected PTLD.