Abstract: SA-PO1222
Post-Transplant Lymphoproliferative Disorder and Graft-vs.-Host Disease After Simultaneous Pancreas-Kidney Transplantation: First Reported Case
Session Information
- Transplantation: Clinical - Complications, Pediatrics, and Multi-Organ Considerations
October 24, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 2002 Transplantation: Clinical
Authors
- Karakadze, Marko Alexander, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
- Simko, Caroline J., University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
- Giusti, Sixto G., University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
- Lyons, Shannon, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
Introduction
Post-transplant lymphoproliferative disorder (PTLD) and donor-derived graft-versus-host disease (GvHD) are rare, life-threatening complications of solid organ transplantation (SOT). To our knowledge, this is the first reported case of concurrent EBV-postivie PTLD and Donor-derived GVHD with hematopoietic engraftment after simultaneous pancreas-kidney (SPK) transplantation.
Case Description
A woman in her 30s with end-stage kidney disease secondary to type 1 diabetes mellitus underwent SPK transplantation from a 13-year-old deceased brain-dead donor and received rabbit anti-thymocyte globulin induction. She developed recurrent polymicrobial infections, persistent cytopenias, and progressive marrow failure. Chimerisim testing confirmed donor-derived GvHD with multilineage involvement, and bone marrow biopsy demonstarated EBV-positive PTLD with viral load exceeding 500,000 copies/mL. Despite aggressive multidisciplinary management, she died on post-transplant day 127 from acute intracranial hemorrhage shortly after recieving stem cell transplant.
Discussion
This case illustrates the diagnostic and therapeutic challenge of concurrent EBV-positive PTLD and donor-derived GvHD after SPK transplantation, further complicated by apparent donor-derived hematopoiesis. The case was diagnostically challenging given overlap between cytopenias, infection, viral reactivation, and drug toxicity. Theorized contributors included the lymphoid tissue burden of a pediatric donor, the intensity of induction therapy, and impaired host immune clearance of donor lymphocytes. This case highlights the importance of maintaining a broad differential for persistent cytopenias after SOT, obtaining early chimerism testing when donor-derived GvHD is suspected, and a multidisciplinary approach. Additional case reporting is needed to better define risk factors, diagnostic thresholds, and management strategies for this rare but frequently fatal presentation.
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