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Posttransplantation lymphoproliferative disorder: manifestations in pediatric thoracic organ recipients
Gye Yeon Lim1, Beverley Newman, Geoffrey Kurland
1Department of Radiology, Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, 3705 Fifth Ave at DeSoto St, Pittsburgh, PA 15213-2583, USA.
Insights
Posttransplantation lymphoproliferative disorder (PTLD) in young thoracic transplant patients often affects lungs and extrathoracic sites. PTLD manifests early, predominantly in the thorax for lung recipients, but extrathoracically for heart recipients.
Area of Science:
- Thoracic transplantation
- Oncology
- Immunology
Background:
- Posttransplantation lymphoproliferative disorder (PTLD) is a significant complication following organ transplantation.
- Understanding PTLD's clinical and imaging features in young thoracic organ recipients is crucial for timely diagnosis and management.
Purpose of the Study:
- To describe and correlate the clinical and imaging features of PTLD in young thoracic organ transplant recipients.
- To differentiate PTLD manifestations between heart and lung transplant recipients.
Main Methods:
- Retrospective review of medical and imaging records of 27 young patients with 31 PTLD episodes after thoracic organ transplantation.
- Analysis of PTLD distribution, timing, and imaging characteristics.
- Comparison of PTLD features between heart and lung transplant recipients.
Main Results:
- PTLD commonly involved intrathoracic sites (55%), presenting as pulmonary nodules or mediastinal adenopathy, and extrathoracic sites (68%), including abdomen, head/neck, and CNS.
- Intrathoracic PTLD was more frequent in lung transplant recipients (89%) than heart recipients (44%).
- Extrathoracic PTLD was more common in heart recipients (83%) than lung recipients (33%), with early onset more prevalent in lung recipients.
Conclusions:
- PTLD in young thoracic transplant recipients frequently involves lungs and extrathoracic organs.
- PTLD tends to have an early onset, particularly in lung transplant recipients.
- Thoracic PTLD is predominant in lung/heart-lung recipients, while extrathoracic PTLD is more common in heart recipients.
Purpose:
To describe and correlate the clinical and imaging features of posttransplantation lymphoproliferative disorder (PTLD) in young thoracic organ transplant recipients.
Materials And Methods:
The authors retrospectively reviewed the medical and imaging records of 31 PTLD episodes in 27 patients with PTLD out of 183 young patients who survived for at least 1 month after thoracic organ transplantation: 18 (14%) heart transplant recipients and nine (16%) lung or heart-lung transplant recipients. Four patients had two separate PTLD episodes. The distribution, timing, and imaging features of the disease were analyzed.
Results:
Seventeen (55%) of 31 episodes involved intrathoracic PTLD manifesting as multiple pulmonary nodules (n = 10), a solitary nodule (n = 3), alveolar consolidation (n = 3), and/or mediastinal adenopathy (n = 8). Extrathoracic PTLD occurred in 21 (68%) of 31 episodes and involved the abdomen (n = 15), head and neck (n = 11), and/or central nervous system (n = 3). The imaging findings of these episodes included bowel wall thickening, lymphadenopathy, and focal masses. Intrathoracic PTLD occurred more commonly in lung transplant recipients (89%) than in heart transplant recipients (44%); no cases of lymphoma involved the thorax. The frequency of extrathoracic manifestations was higher in heart transplant recipients (83%) than in lung transplant recipients (33%). In lung transplant recipients, the prevalence of early-onset PTLD was significantly greater than that in heart transplant recipients (P <.05). Intrathoracic PTLD tended to manifest early.
Conclusion:
PTLD in young thoracic transplant recipients involves the lungs and extrathoracic organs, tends to have an early onset, and manifests predominantly in the thorax in lung transplant and heart-lung transplant recipients, as opposed to heart transplant recipients.
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