PTLD after Lung Transplantation

The specter of post-transplant lymphoproliferative disorder (PTLD) hangs over the lung transplant population like the legendary sword of Damocles, as an ever-present danger which is even more apparent in the pediatric population. The major risk factor, of course, is primary Epstein-Barr virus infection usually transmitted via a seropositive donor into a naive recipient, perhaps facilitated by the considerable amount of lymphoid tissue contained within the donor lungs/heart-lung bloc. Given the rate of donor seropositivity (~85%), the rate of donor positive to recipient negative is approximately 13%, of which, and depending on age and perhaps immune-suppression exposure, 30–50% will develop primary EBV and PTLD. To date, there is no effective preventative therapy nor universally accepted management, although a reduction in level of immune suppression combined with the use of monoclonal antibodies directed against CD-20 has been associated with enduring success, the risk of provoking acute rejection notwithstanding.