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Post-Transplant Lymphoproliferative Disorder Which Developed 45 Years After Kidney Transplantation
Nobuaki Nishima1, Yoshifumi Hamasaki2, Giyoung Kwoun1
1Division of Nephrology and Endocrinology, Graduate School of Medicine, The University of Tokyo, Japan.
Internal Medicine (Tokyo, Japan)
|February 19, 2025
Summary
Post-transplant lymphoproliferative disorder (PTLD) is rare in kidney transplant recipients. This case highlights very late-onset PTLD occurring 45 years post-transplant, emphasizing the need for further research into its unique risks and management strategies.
Area of Science:
- Nephrology
- Oncology
- Transplantation Immunology
Background:
- Post-transplant lymphoproliferative disorder (PTLD) affects 0.8-2.5% of kidney transplant patients.
- PTLD incidence peaks within 1 year and 10-14 years post-transplant.
- Very late-onset PTLD (VL-PTLD), occurring >10 years post-transplant, has unclear characteristics.
Purpose of the Study:
- To describe a unique case of PTLD occurring 45 years after kidney transplantation.
- To highlight the potential distinct features of very late-onset PTLD.
- To underscore the need for further investigation into VL-PTLD risks and management.
Main Methods:
- Case report of a 61-year-old male kidney transplant recipient.
- Clinical presentation: fever and shortness of breath.
- Diagnostic workup: computed tomography (lung and liver masses), biopsy (stage IVB monomorphic PTLD).
Main Results:
- The patient presented with symptoms 45 years post-kidney transplant.
- Imaging revealed lung and liver masses.
- Biopsy confirmed stage IVB monomorphic PTLD.
- Despite initial improvement, the patient expired on day 66.
Conclusions:
- Very late-onset PTLD may present differently from earlier onset PTLD.
- This case underscores the possibility of PTLD occurring decades after transplantation.
- Further research is crucial for understanding and managing VL-PTLD.
