Occurrence of lymphoproliferative disorders in heart transplant recipients

Lymphoproliferative diseases may occur as a complication of severe immunosuppression. In our own center two out of 46 heart transplant recipients, receiving a cyclosporin A containing immunosuppressive regimen, presented with this complication and are reported here. Hepatic involvement and an occult small bowel localisation, which only became evident after a chemotherapy-induced small bowel perforation, illustrate the predilection of posttransplant lymphoproliferations for extranodal sites. Both cases represent the extremes of a spectrum of post-transplant lymphoproliferations ranging from polyclonal benign lesions to monoclonal malignant lymphomas. Their B-cell origin was pathologically established, but in none of the two reported cases the previously postulated role of Epstein-Barr virus in the pathogenesis could be confirmed by serological tests. Severe immunosuppression played a major role in the pathogenesis of these disorders, as suggested by concomitant opportunistic infections occurring in both cases. The lymphoproliferation diagnosed in the polyclonal stage was reversible after reduction of the immunosuppressive therapy, without subsequent graft rejection. This observation underscores the importance of early recognition of lympho-proliferative disorders in organ transplant patients, allowing a prompt and successful reduction of the immunosuppressive therapy. Overwhelming opportunistic infections, occurring in the patient treated with cytotoxic drugs, illustrate the inherent risks of such an approach in an already severely immunosuppressed population.