Abstract: Poster Presentations |

Thoracic Presentations of Posttransplant Lymphoproliferative Disorders FREE TO VIEW

Michael E. Halkos, MD; Joseph I. Miller, MD; Karen P. Mann, MD; Daniel L. Miller, MD; Anthony A. Gal, MD
Author and Funding Information

Emory University School of Medicine, Atlanta, GA


Chest. 2003;124(4_MeetingAbstracts):198S. doi:10.1378/chest.124.4_MeetingAbstracts.198S-a
Text Size: A A A
Published online


PURPOSE:  Post-transplant lymphoproliferative disorders (PTLD) are rare, but significant complications following transplantation. Although organ-specific cases have been reported, primary presentation in the thoracic cavity has not been fully characterized.

METHODS:  11 cases of PTLD with a primary thoracic presentation were identified among solid organ or bone marrow (BM) transplant patients from 1990-2002.

RESULTS:  Patients include 8 men and 3 women (mean age of 49 years). Transplant cases were as follows: 1 heart, 3 lung, 2 kidney/pancreas, 3 kidney, 2 BM, and 0 liver. Time to presentation ranged from 1 to 97 months and was <1 year in 6 and >1 year in 5 cases. Pre-transplant EBV and CMV status were negative in 8/10 and 9/10 cases, respectively. Patients presented with mediastinal adenopathy (7/11) or pulmonary parenchymal lesions (5/11). 6/11 also had extra-thoracic involvement. 8 presented with constitutional symptoms. Pathologic diagnosis was achieved by CT-guided fine needle aspiration (FNA) in 8 patients or by an open biopsy procedure in 3 patients. Pathologic analysis revealed B-cell lymphoproliferative disorder in 9/11 cases, anaplastic large cell lymphoma in 1, and Hodgkin’s lymphoma in 1. 5/6 specimens evaluated for EBV were positive by in situ hybridization or immunohistochemistry. All patients were initially treated with reduction in immunosuppresion and 6 received adjuvant chemotherapy. Overall, mortality was 64%: 4/7 patients died from complications of PTLD (1 heart, 1 BM, 2 kidney), and 3/7 (3 lung) died from rejection. The mean interval from diagnosis to death was 13 months.CONCLUSIONS: PTLD may present in the thoracic cavity regardless of organ transplanted and must be considered as a potentially fatal complication in immuno-suppressed transplant patients. Long-term survival remains poor and is worse for heart or lung recipients who will not tolerate rejection associated with suboptimal drug regimens.

CLINICAL IMPLICATIONS:  Most diagnoses can be obtained via CT-guided FNA. Earlier diagnosis and improvements in chemotherapy and immunosuppresion may improve survival for these high-risk patients.

DISCLOSURE:  M.E. Halkos, None.

Wednesday, October 29, 2003

12:30 PM - 2:00 PM




Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

CHEST Journal Articles
PubMed Articles
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543