Donor or recipient origin of post transplant lymphoproliferative disease after lung transplantation

Abstract

Introduction: Epstein-Barr virus induced Post-transplant Lymphoproliferative Disease (PTLD) is an important source of morbidity and mortality after lungtransplantation (Ltx). Only sporadic cases of donor origin PTLD are reported in literature. The origin is crucial in treatment strategies using EBV specific Cytotoxic T-Lymphocytes (EBV-CTL’s), because of the HLA restriction. Methods: Donor or recipient origin of the PTLD’s of our Ltx patients by HLA-DR typing using a nested PCR. DNA was isolated from B cell outgrowths of biopsies for 4 PTLD’s, single cells for 1 PTLD’s and crude biopsy material from brain tissue in one PTLD. Results: Sofar of 17 PTLD’s we were able to discriminate origin of PTLD in 6 patients. Four PTLD’s were of recipient origin but 2 PTLD’s were of donor origin. Donor origin PTLD’s presented at 3 and 6 months after transplantation and were localized in the lungs and the other in the brain. Conclusion: Before treatment of PTLD with EBV specific CTL’s after lungtransplantation, the origin of the PTLD should be determined, since donor type PTLD might occur more frequent than reported.