Posttransplant lymphoproliferative disorders in lung transplant recipients: clinical experience at a single center.

OBJECTIVES: Posttransplant lymphoproliferative disorders (PTLD) can be a significant cause of morbidity in lung transplant (LT) recipients. Risk factors include Epstein-Barr virus (EBV) infection, particularly primary infection, and immunosuppression. This article updates the incidence and presentation of PTLD at our lung transplant program. METHODS: We retrospectively reviewed the immunosuppression, EBV serology, and cases of PTLD among 129 lung transplant recipients at risk who survived > 1 month. RESULTS: There were two cases of PTLD among 129 LT patients, 2/129 (1.6%). One of these patients was among the 6 EBV seroconverters, 1/6 (16.7%), and had a typical presentation of PTLD in the allograft resulting in dissemination and death. The second case of PTLD developed in an EBV seropositive recipient who presented 33 months following LT with isolated colonic involvement. He subsequently died from chronic rejection. CONCLUSIONS: The incidence of PTLD in a LT program with a large EBV seropositive population is low, 1.6%. The presentation of PTLD in LT recipients is variable and may present typically with allograft involvement in the first year following transplantation, or late with isolated, extrapulmonic involvement.

Preoperative assessment of the transplant patient.

In the authors' university medical center, there are an increasing number of transplant patients presenting for foot surgery. Newer immunosuppressive agents are largely responsible for improvement of graft and patient survival and hence more patients requiring and wanting foot surgery. Podiatric surgeons must approach these patients with caution, but not fear. Transplant patients are more susceptible to infection, have altered response to stress from surgery, and may have delayed wound healing. Preoperative assessment and planning are imperative when considering surgery for transplant patients.