Supplementary Material for: A case of early occurrence of post-transplant lymphoproliferative disorders in the allograft after kidney transplantation

Introduction: Post-transplant lymphoproliferative disorder (PTLD) is a serious complication after transplantation (Tx). The incidence pattern appears to be divided into two groups, depending on the onset time, as within 1 or 2 years after Tx and thereafter (early and late, respectively). We report very early onset and rapid progression of PTLD after kidney Tx. Case Presentation: A 49-year-old man with a 12-year history of hemodialysis underwent deceased donor kidney Tx from a 62-year-old male donor. Serological examination revealed negative antibodies in the recipient for viral capsid and Epstein-Barr virus (EBV)-associated nuclear antigens. Graft function recovery was delayed, possibly because of recurrent bacterial urinary tract infections, and the patient was weaned from dialysis on day 17. The protocol biopsy on day 37 showed moderate mononuclear cell infiltration in the interstitium with tubulitis. Urine output decreased, and the serum creatinine level rose abruptly at approximately the same time as we initiated steroid pulse therapy. The allograft biopsy was repeated on day 52 and demonstrated large atypical lymphoid cells in the parenchyma. Tumor cells were positive for CD 20 and negative for CD3 with immunostaining, and positive on EBV-encoded RNA in situ hybridization. The diagnosis was EBV-associated PTLD, histologically diffuse large B-cell lymphoma. Hemodialysis was resumed, and graftectomy was performed on day 58. At 12 months post-graftectomy, the patient was alive on dialysis, and imaging studies had revealed no extra-graft lesions. Conclusion: Early onset and rapid progression of PTLD after Tx should be considered by transplant surgeons and physicians.

引言：移植后淋巴增殖性疾病（Post-transplant lymphoproliferative disorder, PTLD）是移植（transplantation, Tx）术后的严重并发症。根据发病时间，其发病特征可分为两类：移植术后1或2年内发病（早期）与术后2年以后发病（晚期）。本文报告1例肾移植（kidney Tx）术后极早期发病且病情快速进展的PTLD病例。
病例报告：1例有12年血液透析病史的49岁男性患者，接受了来自62岁男性供体的尸体供肾移植。血清学检测显示，受体的病毒衣壳抗原及EB病毒（Epstein-Barr virus, EBV）相关核抗原抗体均呈阴性。患者移植肾功能恢复延迟，推测与复发性细菌性尿路感染相关，并于术后第17日脱离透析。术后第37日行方案活检，结果提示间质中度单核细胞浸润伴小管炎。随后患者尿量减少，血清肌酐水平骤升，该时间点恰与我们启动类固醇冲击治疗的时间重合。术后第52日再次行移植肾活检，可见肾实质内存在大的非典型淋巴样细胞。免疫染色结果显示，肿瘤细胞CD20阳性、CD3阴性，EB病毒编码RNA原位杂交检测呈阳性。最终确诊为EB病毒相关PTLD，组织学类型为弥漫性大B细胞淋巴瘤。患者重新接受血液透析，并于术后第58日行移植肾切除术。移植肾切除术后12个月，患者仍存活并维持透析，影像学检查未发现移植物外病灶。
结论：移植外科医师与临床医师应警惕移植术后PTLD的极早期发病与快速进展。