[ISPHLT-OS2-2] Post-transplant lymphoproliferative disorder after living-donor lung transplantation in pediatric patients
We report 3 cases of post - transplant lymphoproliferative disorder (PTLD) in pediatric recipients after living - donor lung transplantation (LDLT). In all cases, the increase in blood Epstein - Barr virus (EBV) - DNA copies and the involvement of EBV in tumor were observed. Immunosuppression was reduced after the diagnosis with or without additional therapy. PTLD was successfully managed in the short - term, although long - term follow - up was required. Case 1. Six - year - old male underwent right sided LDLT for alveolar capillary dysplasia with misalignment of pulmonary veins. Six months after surgery, the huge left lung tumor 48 mm in size with high FDG uptake on PET - CT scan was observed and the transthoracic biopsy revealed PTLD. The tumor was positive for CD20 and chemotherapy with rituximab was given. The size of tumor and FDG uptake were remarkably decreased. Seven months after the diagnosis, native left upper lobectomy was performed with the pathological finding of no residual tumor. The patient is alive 2 years after the diagnosis. Case 2. Six - year - old male underwent right sided LDLT for interstitial pneumonia after the chemotherapy for bladder rhabdomyosarcoma. Five months after surgery, lymphadenopathy was developed with high FDG uptake on PET - CT scan. The biopsy of cervical lymph node revealed PTLD. The tumor was positive for CD20 and rituximab was administered, resulting in the improvement of lymphadenopathy. The patient is alive 4 months after the diagnosis. Case 3. Four - year - old male underwent bilateral LDLT for interstitial pneumonia after the chemotherapy for malignant lymphoma. EBV antibody profile showed previous infection pattern only in this case. Three months after surgery, the left lung nodule 14 mm in size with high FDG uptake on PET - CT scan was noticed, which was diagnosed as PTLD by the transthoracic biopsy. Although the tumor was positive for CD20, he was treated with reduced immunosuppression only due to hemorrhagic cystitis. FDG uptake in lung nodule was remarkably decreased and the patient is alive 2 months after the diagnosis.