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PTLD Incidence and Risk Factors — ESENeph MCQ

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ModerateTransplantationPTLD Incidence and Risk FactorsESENeph

A kidney transplant recipient 8 years post-transplant presents with weight loss, night sweats, and a new lymph node mass. Biopsy confirms diffuse large B-cell lymphoma (DLBCL). EBV is positive. How common is PTLD in kidney transplant recipients?

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Correct answer: C — PTLD occurs in 1-3% of kidney transplant recipients; it is the most common malignancy (after skin cancer) and risk increases with EBV seronegative recipients, intensity of immunosuppression, and time post-transplant

PTLD is the most common non-skin malignancy in kidney transplant recipients, occurring in 1-3% (higher in EBV-seronegative recipients). Risk factors include EBV seronegativity at transplant, intensity of immunosuppression (particularly T-cell depleting agents), CMV disease, and time post-transplant (bimodal: early polymorphic PTLD and late monomorphic PTLD). Treatment is reduction of immunosuppression followed by Rituximab (for CD20-positive disease) and chemotherapy (R-CHOP) for aggressive or refractory disease.

Reference: KDIGO 2009 – Transplant; NICE NG52 – NHL