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Abstract: SA-PO840

A Fatal Case of T-Cell Post-Transplant Lymphoproliferative Disorder After Kidney Transplant Deteriorating to Acute Liver Failure

Session Information

Category: Transplantation

  • 2002 Transplantation: Clinical

Authors

  • Cho, Jeongmin, Seoul National University Hospital, Jongno-gu, Seoul, Korea (the Republic of)
  • Kim, Yong Chul, Seoul National University Hospital, Jongno-gu, Seoul, Korea (the Republic of)
  • Kim, Yon Su, Seoul National University Hospital, Jongno-gu, Seoul, Korea (the Republic of)
  • Lee, Hajeong, Seoul National University Hospital, Jongno-gu, Seoul, Korea (the Republic of)
Introduction

Post-transplant lymphoproliferative disorder (PTLD) is a rare and serious complication of kidney transplantation (KT). PTLD, mostly of B-cell lineage, progresses even after reduction of immunosuppression in half of patients. Herein, we report a deteriorating case of T-cell PTLD after KT, that rapidly progressed to liver failure, septic shock, and death despite various therapeutic attempts.

Case Description

A 50-year-old woman received HLA-incompatible, ABO-compatible pre-emptive KT for her diabetic end-stage kidney disease under basiliximab induction treatment. In the routine surveillance, Epstein-Barr (EB) viral copies elevated with 318,443 copies/mL at 2 months after KT. EB viremia continued to increase in spite of reducing maintenance immunosuppressive agents or preemptive rituximab treatment. At 8 months after KT, she was admitted due to fever and found multifocal splenic lesions and nonspecific lymph node enlargement in the abdomen-pelvis CT (Figure 1). After then, her liver function test started to elevate without any evidence of hepatitis-viral infection. Considering PTLD, we performed a percutaneous liver biopsy and confirmed EBV-associated T-cell PTLD with CD3 and CD56 expression (Figure 2). Because of the absence of proven treatment for the T-cell lineage PTLD, we just monitored her watchfully. Only 2-month after PTLD diagnosis, she was admitted for acute and severe liver failure. We tried rescue cytotoxic chemotherapy at hospital day 6, although she died at 12 days after hospitalization.

Discussion

This is a case of very rare and refractory EB virus-associated T-cell PTLD after KT does not have any specific treatment option until now. Further studies for a preventative and therapeutic method for T-cell lineage PTLD are warranted.

Figure 1. CT findings of hepatic nodules in (A) Arterial and (B) Venous phase indicating liver involvement of PTLD. (C) PTLD with lymph node and (D) splenic involvement.

Figure 2. Pathologic findings of T-cell PTLD of liver. H&E stain (A), lymphoid cells Positive for CD3 (B), Ki67 (C), CD56 (D), and EBV (E).