Post Transplantation Lymphoproliferative Disorder (PTLD) Presenting as Biliary Duct Obstruction

Abstract

After adult liver transplantation (LT), post-transplant lymphoproliferative disorder (PTLD) is an uncommon but serious complication of immunosuppression (IMS) in presence of an acute or latent EBV infection. The clinical pres- entation of this disease is aspecific, and, after LT, it may mimic anastomotic bile duct stricture. We report the cases of 2 adult patients who developed, 3 months and 8 years after OLT, an EBV-associated PTLD with diffuse intrinsic infiltration of bile duct mimicking anastomotic biliary stricture. In the absence of liver or hilar nodes in- volvement, percutaneous biopsies were non contributive and the diagnosis were made by surgical biopsy. After reduction of IMS and Rituximab treatment, both patients are alive without recurrence 5 and 6 years after diagnosis. In conclusion, PTLD is one of the differential diagnosis of biliary tree obstruction after OLT. Diagnosis requires surgical biopsies and treatment consists in IMS reduction and Rituximab.