Clinical Analysis of Posttransplant Lymphoproliferative Disorder After Liver Transplant

Objectives: Posttransplant lymphoproliferative disorder is a severe and potentially fatal complication after liver transplant, resulting from immunosuppressiondriven uncontrolled lymphoid proliferation. In this study, we aimed to analyze the incidence, clinicopathological characteristics, management, and outcomes of posttransplant lymphoproliferative disorder in liver transplant recipients. Materials and Methods: We conducted a retrospective analysis of 1288 patients who underwent liver transplant between January 2015 and December 2024. Among them, 8 recipients (0.62%) were diagnosed with posttransplant lymphoproliferative disorder based on histopathological and clinical criteria. Baseline characteristics, clinicopathological characteristics, management, and outcome data were collected and statistically evaluated. Results: Age at time of transplant was 55.5 years (range, 44-62 years), and posttransplant lymphoproliferative disorder was diagnosed at 10.5 months posttransplant (interquartile range, 7.5-28.5 mo; range, 5-44 mo). Clinical manifestations were diverse and nonspecific, with 6 having allograft involvement (75%) and 7 having detectable Epstein-Barr virus positivity (87.5%). Monomorphic B-cell posttransplant lymphoproliferative disorder (B-cell lymphomas and diffuse large B-cell lymphoma) was the most common subtype (87.5%). All recipients with posttransplant lymphoproliferative disorder received immunosuppression reduction or withdrawal. Three patients with diffuse large B-cell lymphoma-type received chemotherapy, 1 with central nervous system-type received rituximab plus cyclophosphamide, and 1 received rituximab combined with radiofrequency ablation for liver lesions. Of the 8 recipients, 3 had remission and 5 died due to sepsis complications and posttransplant lymphoproliferative disorder. Median time from diagnosis of posttransplant lymphoproliferative disorder to death was 2 months (range, 1.5-5.5 mo). Conclusions: Posttransplant lymphoproliferative disorder, characterized by heterogeneous manifestations, remains a serious complication after liver transplant. Early diagnosis requires a combination of Epstein-Barr virus DNA monitoring and imaging. Definitive pathological diagnosis and classification are essential for guiding treatment strategies, including reduction of immunosuppression and rituximab-based chemotherapy.