Posttransplantation Lymphoproliferative Disorder Associated with OKT3 and Decreased Antiviral Prophylaxis in Pancreas Transplant Recipients

posttransplantation lymphoproliferative disorder (PTLD) occurring within 62 days of pancreas transplantation. The development of PTLD was associated with both a significantly higher total muromonab-CD3 (OKT3) dose and a lack of ganciclovir/acyclovir prophylaxis, but it was not associated with the total dose of antithymocyte globulin or cytomegalovirus serostatus. All four patients were treated aggressively and survived without evidence of recurrent PTLD more than 1.5 years later. We conclude that the use of a high total dose of OKT3 puts pancreas transplant recipients at increased risk for early onset PTLD, while ganciclovir/acyclovir prophylaxis may help to prevent this disorder; however, if early onset PTLD does occur in these patients, aggressive therapy can lead to a favorable outcome. Posttransplantation lymphoproliferative disorder (PTLD) re- Methods sults from Epstein-Barr virus (EBV)–associated proliferation Patient Populationof B lymphocytes in the immunosuppressed host [1, 2]. The spectrum of disease associated with PTLD ranges from rela- One hundred and four simultaneous pancreas and kidney tively benign polyclonal plasmacytic hyperplasia to malignant transplantations and six pancreas transplantations alone were immunoblastic lymphoma or multiple myeloma [1–3]. performed at the University of Maryland Hospital (Baltimore