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Post-transplant lymphoproliferative disorder is a clearly recognized and potentially life threatening complication after solid organ or bone marrow transplantation. It comprises a spectrum of diseases ranging from infectious mononucleosis and lymphoid hyperplasia to highly aggressive lymphoma. PTLD is a relatively common malignancy after transplantation with a reported incidence ranging from 2% to 10%. It’s the most common form of post-transplant malignancy after skin cancer with an overall mortality often exceeding 50% (Purtilo et al., 1980; Leblond et al., 1995). Most cases of PTLD are associated with Epstein Barr virus (EBV) that leads to uncontrolled B cell proliferation in patients with a decreased function of EBV specific T cell because of immunosuppressive drugs. PTLD is not exclusively associated with EBV infection as EBV-negative PTLD, often developing late after transplantation. Post transplant lymphomas differ from lymphomas in general population in histopathological findings, increased extranodal involvement, a more aggressive clinical course and poorer response to conventional treatment. Registry-based reports however usually do not provide details of treatment and outcome: the existing single institution studies are largely reports and only a few studies include a significant number of patients with PTLD. Treatment of PTLD consists always in reduction of immunosuppression as first step. The role of chemotherapy remains unclear. In the past it was reserved for patients in whom other treatment options have failed even if the increased toxicities from cytotoxic agent, the high susceptibility to life-threatening infections. Actually most authors consider new anti CD20 mAB essential for treatment or as single agent or in association with CT but there is not a definitive agreement about schedules, duration of treatment and setting of patients.

Post-Trasplant Lymphoproliferative Disorders (PTLD) in Adult Kidney Trasplantated Patients