PTLD Management — ESENeph MCQ
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Correct answer: B — Reduce immunosuppression in a coordinated transplant and haematology plan
The best answer is “Reduce immunosuppression in a coordinated transplant and haematology plan”. Restoring antiviral immune surveillance through carefully reduced immunosuppression is fundamental; rituximab and chemotherapy are selected from response, CD20 status and disease risk. “Increase immunosuppression to suppress EBV-driven inflammation” is less appropriate because greater T-cell suppression can worsen PTLD “Use radiotherapy for a localised staged lesion unsuitable for systemic therapy” is less appropriate because systemic disease requires histology- and burden-directed treatment “Start full-dose R-CHOP in every patient before reviewing immunosuppression” is less appropriate because treatment is risk-adapted and reduction is a central initial step “Stop all immunosuppression abruptly without graft-risk assessment” is less appropriate because reduction must balance lymphoma control and rejection
Reference: UK Kidney Association post-operative care guideline for kidney-transplant recipients: https://www.ukkidney.org/health-professionals/guidelines/post-operative-care-kidney-transplant-recipient