24^th European Nephrology Conference

Biography

Biography: Julia Paravizo Lello Santos

Abstract

We present two cases of acute abdominal surgical presentations, secondary to PTLD developing after renal transplantation.

Case 1: A 45-year-old male underwent a livinghaploidentical donor renal transplantation and received immunosuppression therapy (cyclosporine, mycophenolate mofetil, and prednisolone). Nine years after transplantation his graft function was stable (creatinine 1.1 mg/dL), when presented with diffuse abdominal pain with perforation intestine signals. The pathological finding were compatible with post-transplant lymproliferative monomorphic disorder, high-grade lymphocytes of B-cell origin by their CD20 positivity and co-expression of CD10 and negative for BCL 2.In situhybridization for EBV-encoded RNA (EBER) was strongly positive (Figure 1). Patient had mTOR conversion, and sirolimus was included in the immunosuppression schedule.

Case 2: A 35-year-old female was submitted to a renal transplant with HLA-distinct living related donor, receiving prednisone, cyclosporine and azathioprine. After 13 years with stable clinical/laboratorial outcomes, she was attended with small bowel obstruction symptoms. The cells in this tumour were confirmed immunohistochemically as lymphocytes of B-cell (Figures 2) origin by their CD20 (Figure 3) and CD79a, with a proliferation rate of 80% (Ki67). Sirolimus was initiated with CNI suspension.

Discussion: PTLD has become an important comorbidity in kidney transplant recipients. Some studies focus on the differences between early-onset and late-onset PTLD, that is, the segregation between EBV-driven disease versus later coincidental lymphomas expected in the general immunocompetent population. The disease can occur in a wide range of locations. Minimization of immunosuppression is the mainstay of treatment after PTLD diagnosis and a multidisciplinary oncological approach is essential.