Epstein-Barr virus-associated lymphoproliferative disorder of donor origin after heart transplantation

Abstract

Post-Transplant Lymphoproliferative Disorder (PTLD) represents a group of lymphomas, which may develop after solid organ transplantation and decrease the survival of transplant recipients. The main challenge of treatment is to achieve disease remission by avoiding the risk of allograft rejection. This report describes a successful treatment of PTLD in an adult patient who underwent allogeneic stem cell transplantation as a child and cardiac transplantation as a young adult. We present the case of a 33-year-old female, who was diagnosed with a Diffuse Large B-Cell Lymphoma (DLBCL) triggered by Epstein - Barr virus (EBV) 8 months after receiving orthotopic heart transplantation from an EBV-positive donor. The patient was treated with R-CHOP chemotherapy followed by maintenance therapy with rituximab, resulting in complete morphologic and metabolic remission of the lymphoma. The echocardiographic examinations and routine endomyocardial biopsies performed during and after chemotherapy did not reveal any signs of cardiac allograft rejection. The patient was asymptomatic on Heart Failure (HF) therapy and continued to remain in complete remission after the cancer treatment. This case underlines the importance of timely surveillance and treatment of seronegative patients after receiving EBV-positive donor organs. Keywords: post-transplant lymphoproliferative disorder; EpsteinBarr virus; immunosuppression; cardiac transplantation; chemotherapy