Surgical management of gastrointestinal posttransplant lymphoproliferative disorders in liver transplant recipients

Ruy J. Cruz, Sumana Ramachandra, Eisaburo Sasatomi, Andrea Dimartini, Michael De Vera, Paulo Fontes, Christopher Hughes, Abhinav Humar

Research output: Contribution to journalArticlepeer-review

23 Scopus citations

Abstract

BACKGROUND: Posttransplant lymphoproliferative disorder (PTLD) is a well-established complication of immunosuppression. The involvement of the gastrointestinal (GI) tract occurs in 25% of all cases of PTLD. Fortunately, surgical intervention is seldom required. We report our experience of surgical treatment of complicated GI-PTLD after liver transplantation (LTx). METHODS: A retrospective analysis of 5677 adult patients who underwent LTx between 1983 and 2009 was conducted. RESULTS: Thirty-six patients presented with GI-PTLD. Sixteen patients presented with complications associated with GI-PTLD requiring emergency surgery. The average (SD) time from LTx to GI surgery was 7.9 (5.8) years (range, 4 months to 17 years). Indications for surgical intervention were small bowel obstruction (seven cases), perforation (six cases), and GI bleeding (three cases). Most GI-PTLD occurred in the small bowel or right colon (81%). In addition to the surgery, treatment of PTLD consisted of reduction of immunosuppression, use of rituximab (n=10), and systemic chemotherapy (n=7). Overall mortality was 69%, with most of the deaths occurring within 8 months after emergency laparotomy. GI bleeding and perforation were associated with higher mortality (>66%). Despite higher early mortality in the surgical group, no differences on long-term outcome were observed between patients with GI-PTLD who required surgery and those who did not (P=0.371). CONCLUSIONS: In summary, GI-PTLD requiring surgical intervention is an extremely rare condition with high early mortality. Most of the cases are monoclonal, present a late onset, and involve the lower GI tract. Intestinal obstruction is the main indication for surgical intervention and is associated with better prognosis.

Original languageEnglish (US)
Pages (from-to)417-423
Number of pages7
JournalTransplantation
Volume94
Issue number4
DOIs
StatePublished - Aug 27 2012
Externally publishedYes

Keywords

  • Epstein-Barr virus infections
  • Immunosuppression
  • Lymphoma
  • Lymphoproliferative disorders
  • Small bowel
  • Transplantation

ASJC Scopus subject areas

  • Transplantation

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