Post-transplant Lymphoproliferative Disorder Following Cardiac Transplantation

Frontiers in Cardiovascular Medicine

article

Rabea Asleh¹  Hilmi Alnsasra¹  Thomas M. Habermann⁴  Alexandros Briasoulis⁵  Sudhir S. Kushwaha¹ 

[1] Department of Cardiovascular Diseases, Mayo Clinic;Heart Institute, Hadassah University Medical Center, Faculty of Medicine, Hebrew University of Jerusalem;Soroka University Medical Center, Ben Gurion University of the Negev;Division of Hematology, Department of Medicine, Mayo Clinic;Division of Cardiovascular Disease, University of Iowa Hospitals and Clinics

关键词: PTLD;    heart transplantation;    Epstein-Barr virus;    immunosuppression;    mTOR inhibitors;    rituximab;   

DOI  :  10.3389/fcvm.2022.787975

学科分类：地球科学(综合)

来源: Frontiers

【 摘 要 】

Post-transplant lymphoproliferative disorder (PTLD) is a spectrum of lymphoid conditions frequently associated with the Epstein Barr Virus (EBV) and the use of potent immunosuppressive drugs after solid organ transplantation. PTLD remains a major cause of long-term morbidity and mortality following heart transplantation (HT). Epstein-Barr virus (EBV) is a key pathogenic driver in many PTLD cases. In the majority of PTLD cases, the proliferating immune cell is the B-cell, and the impaired T-cell immune surveillance against infected B cells in immunosuppressed transplant patients plays a key role in the pathogenesis of EBV-positive PTLD. Preventive screening strategies have been attempted for PTLD including limiting patient exposure to aggressive immunosuppressive regimens by tailoring or minimizing immunosuppression while preserving graft function, anti-viral prophylaxis, routine EBV monitoring, and avoidance of EBV seromismatch. Our group has also demonstrated that conversion from calcineurin inhibitor to the mammalian target of rapamycin (mTOR) inhibitor, sirolimus, as a primary immunosuppression was associated with a decreased risk of PTLD following HT. The main therapeutic measures consist of immunosuppression reduction, treatment with rituximab and use of immunochemotherapy regimens. The purpose of this article is to review the potential mechanisms underlying PTLD pathogenesis, discuss recent advances, and review potential therapeutic targets to decrease the burden of PTLD after HT.

【 授权许可】

CC BY