Gastrointestinal manifestations, risk factors, and management in patients with post-transplant lymphoproliferative disorder: A systematic review

William Reiche; Abubakar Tauseef; Ahmed Sabri; Mohsin Mirza; David Cantu; Peter Silberstein; Saurabh Chandan

doi:10.5500/wjt.v12.i8.268

Gastrointestinal manifestations, risk factors, and management in patients with post-transplant lymphoproliferative disorder: A systematic review

World J Transplant. 2022 Aug 18;12(8):268-280. doi: 10.5500/wjt.v12.i8.268.

Authors

William Reiche¹, Abubakar Tauseef², Ahmed Sabri³, Mohsin Mirza², David Cantu³, Peter Silberstein⁴, Saurabh Chandan⁵

Affiliations

¹ Department of Medicine, CHI Creighton University Medical Center, Omaha, NE 68124, United States. reichewilliam@gmail.com.
² Department of Medicine, CHI Creighton University Medical Center, Omaha, NE 68124, United States.
³ Department of Pathology, CHI Creighton University Medical Center, Omaha, NE 68124, United States.
⁴ Division of Hematology and Oncology, Department of Medicine, CHI Creighton University Medical Center, Omaha, NE 68124, United States.
⁵ Division of Gastroenterology and Hepatology, Department of Medicine, CHI Creighton University Medical Center, Omaha, NE 68124, United States.

Abstract

Background: Patients with a history of solid organ transplantation (SOT) or hematopoietic stem cell transplantation (HSCT) are at an increased risk of developing post-transplant lymphoproliferative disorder (PTLD). The gastrointestinal (GI) tract is commonly affected as it has an abundance of B and T cells.

Aim: To determine typical GI-manifestations, risk factors for developing PTLD, and management.

Methods: Major databases were searched until November 2021.

Results: Non-case report studies that described GI manifestations of PTLD, risk factors for developing PTLD, and management of PTLD were included. Nine articles written within the last 20 years were included in the review. All articles found that patients with a history of SOT, regardless of transplanted organ, have a propensity to develop GI-PTLD.

Conclusion: GI tract manifestations may be nonspecific; therefore, consideration of risk factors is crucial for identifying GI-PTLD. Like other lymphoma variants, PTLD is very aggressive making early diagnosis key to prognosis. Initial treatment is reduction of immunosuppression which is effective in more than 50% of cases; however, additional therapy including rituximab, chemotherapy, and surgery may also be required.

Keywords: Epstein-Barr virus; Gastrointestinal manifestations; Post-transplant lymphoproliferative disorder; Reduction of immunosuppression; Risk factors.