Post-Liver Transplant Lymphoproliferative Disorder Presenting as Biliary Stricture.

Area of Science:

• Hepatology
• Transplant Surgery
• Oncology

Background:

• Nonalcoholic steatohepatitis (NASH) cirrhosis is a leading indication for orthotopic liver transplantation (OLT).
• Post-transplant lymphoproliferative disorder (PTLD) is a rare but serious complication following solid organ transplantation.
• Biliary complications are common after OLT, with ischemic strictures being a frequent cause.

Observation:

• A 63-year-old male recipient of OLT for NASH cirrhosis presented with obstructive jaundice one year post-transplant.
• Initial assessment suggested an ischemic anastomotic biliary stricture.
• Further investigation revealed a mass encasing the bile duct, causing malignant biliary obstruction, later diagnosed as PTLD with metastasis.

Findings:

• PTLD involving the bile duct can mimic ischemic strictures in OLT recipients.
• Reduction of immunosuppression combined with systemic chemotherapy achieved complete remission of PTLD.
• This case highlights a rare presentation of PTLD as a cause of biliary obstruction.

Implications:

• Clinicians should maintain a high index of suspicion for PTLD in OLT patients with obstructive jaundice, even if ischemic stricture is initially suspected.
• Management of PTLD in transplant recipients requires a multidisciplinary approach involving oncologists and transplant hepatologists.
• Timely diagnosis and appropriate treatment of PTLD can lead to favorable outcomes, including complete remission.