Simultaneous Development of Diffuse Immunoblastic Lymphoma in Recipients of Renal Transplants From a Single Cadaver Donor: Transmission of Epstein-Barr Virus and Triggering by OKT3

Rapidly progressive diffuse immunoblastic lymphoma is an uncommon but devastating complication of organ transplantation that typically occurs early in the postoperative period. The fulminant course is characterized by progressive encephalopathy and coagulopathy, with malignant B-cell infiltration in the graft and other sites. Both de novo infection with Epstein-Barr virus (EBV) and treatment with the monoclonal antibody OKT3 have been implicated in the development of this disorder. We report two patients who received renal transplants from the same cadaver donor, with transmission of EBV from the same source, in whom treatment with OKT3 for acute rejection triggered the simultaneous development of fulminant and fatal B-cell immunoblastic lymphoma. We suggest that antilymphocyte agents be used with caution in EBV-seronegative graft recipients who receive a transplant from an EBV-seropositive donor to minimize the risk of this lethal complication.