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Srpski arhiv za celokupno lekarstvo 2018 Volume 146, Issue 1-2, Pages: 81-85
https://doi.org/10.2298/SARH170131099P
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Lymphoproliferative disorder after kidney transplantation

Petrović Lada ORCID iD icon (Clinical Center of Vojvodina, Clinic of Nephrology and Clinical Immunology, Novi Sad + Faculty of Medicine, Novi Sad)
Đurđević-Mirković Tatjana (Clinical Center of Vojvodina, Clinic of Nephrology and Clinical Immunology, Novi Sad + Faculty of Medicine, Novi Sad)
Mitić Igor (Clinical Center of Vojvodina, Clinic of Nephrology and Clinical Immunology, Novi Sad + Faculty of Medicine, Novi Sad)
Božić Dušan (Clinical Center of Vojvodina, Clinic of Nephrology and Clinical Immunology, Novi Sad + Faculty of Medicine, Novi Sad)
Urošević Ivana (Faculty of Medicine, Novi Sad + Clinical Center of Vojvodina, Clinic of Haematology, Novi Sad)

Introduction. Post-transplant lymphoproliferative disorder (PTLD) is one of the most severe and often fatal complications observed after solid organ and bone marrow transplantations. Case outline. We present a case of a patient born in 1989 who underwent a living related donor renal transplantation at the age of 16. Induction therapy implied the administration of anti-thymocyte globulin and corticosteroids, and maintenance therapy encompassed a combination of three immunosuppressive agents – tacrolimus, mycophenolate mofetil, and corticosteroid. The patient experienced first complications six months after transplantation, manifested as aggravation of tonsillitis symptoms and subsequent dysphagia. Histopathological and immunohistochemical finding of tonsillectomy specimens suggested polymorphic PTLD (with high expression of Epstein–Barr virus latent membrane protein antigen). Definitive diagnosis of diffuse large B-cell lymphoma (CD20+) was established upon analysis of oesophageal bioptate. Antiviral therapy was applied, along with rituximab and a combination of cyclophosphamide, doxorubicin (hydroxydaunomycin), vincristine, and prednisolone (CHOP therapy), whilst the dosage of basic immunosuppressive drugs was reduced. Complex diagnostic procedures confirmed the absence of disease recurrence and stable graft function five years after completing the PTLD therapy. Conclusion. The presented case of our patient, who developed PTLD after renal transplantation, demonstrated that appropriate early diagnosis, reduction of immunosuppressive regimens, and vigilant application of immunomodulatory and chemotherapy could result in complete disease remission, yet preserving and maintaining the stable function of the transplant.

Keywords: kidney transplantation, post-transplant lymphoproliferative disorder, immunosupression