CL Nash¹, LM Price¹, S Yilmaz², A Barama², F Sepandj³, D Stewart⁴

Department of ¹Gastroenterology, ²Division of Transplantation, Departments of ³Nephrology and ⁴Oncology, University of Calgary, Calgary, Alberta, Canada

Post-transplant lymphoproliferative disorder (PTLD) is a specific type of lymphoproliferative disease often induced by Epstein-Barr virus (EBV) following immunosuppression. In the adult kidney transplant population, the incidence ranges from 0.7-4%. The majority of cases involve a single site, and arise on average 7 months following transplantation. Symptoms at presentation vary according to the site of involvement. Histopathology usually reveals B-cell proliferative disease and has been standardized into its own classification. Treatment modalities consist of decreased immunosuppression, EBV eradification, systemic chemotherapy, surgical resection and monoclonal antibody therapy. Despite this, mortality remains high with typically short survival duration . In the renal transplant population, approximately 10% of PTLD's present with gastrointestinal symptomatology and disease. Reported sites include the stomach and small and large bowel. No associations of PTLD and Helicobacter pylori or mucosa-associated lymphoid tissue have been described. In the era of cyclosporine immunosuppression, PTLD affecting the gastrointestinal tract may be increasing, in comparison with the rates of occurrence during older immunosuppression regimens. We present a case of antral PTLD and H pylori infection occurring three months following kidney transplantation with a review of the natural history and management of gastric PTLD.

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