The clinical diversity and role of chemotherapy in lymphoproliferafive disorder in liver transplant recipients

Michelle McCarthy, John Ramage, Alistair McNair, Edward Gane, Bernard Portmann*, Anthony Pagliuca, Mohamed Rela, Nigel Heaton, Ghulam J. Mufti, Roger Williams

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

41 Citations (Scopus)


Background/Aims: Post-transplant lymphoproliferative disorder is a well- documented complication with an incidence ranging from 2 to 10%, depending on the organ transplanted. Yet despite our increased understanding of the pathophysiology of this disease and the various treatments available, the mortality remains high at 60-80%. We present the clinical and histological features of ten adult liver transplant recipients with post-transplant lymphoproliferative disorder presenting over a 15-year period and review the therapeutic options. Methods: CD20/CD45RO immunostaining was used for T/B- cell markers; polymerase chain reaction and in-situ hybridisation for Epstein-Barr virus genome detection; κ/λ immunostaining and gene rearrangement analysis for clonality. Results: There were six females and four males (age range 24-56) with onset of post-transplant lymphoproliferative disorder-symptoms ranging from 3 to 72 months post transplant. Sites of post-transplant lymphoproliferative disorder included liver (n=4), lymph nodes (n=5), bone marrow (n=2), lungs (n= 2), kidneys (n=2), brain, ovaries, : and pancreas (n= 1). All lesions were classified as high-grade lymphoma, of B-cell lineage (9 tested); Epstein-Barr virus genome was detected in 7/10 cases. Three tumours were monoclonal; four were polyclonal and three undetermined. Treatment included immunosuppression reduction, antiviral therapy with acyclovir and/or chemotherapy (CHOP or VAPEC-B). Survival times for those patients not treated with chemotherapy were from 9 days to 30 months, whereas those receiving chemotherapy had remission times of 4 to 48 months. Conclusions: Longer-term remissions can be achieved in patients treated with systemic chemotherapy, although not without morbidity. Clonality assessment is important but treatment decisions should be based primarily on clinical features of progression, as polyclonal tumours can behave as aggressively as monoclonal tumours.

Original languageEnglish
Pages (from-to)1015-1021
Number of pages7
JournalJournal of Hepatology
Issue number6
Publication statusPublished - Dec 1997


  • Chemotherapy
  • EB virus
  • Liver transplantation
  • Lymphoproliferative disorder


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