J Korean Soc Transplant.  2016 Mar;30(1):44-49. 10.4285/jkstn.2016.30.1.44.

Post-transplant Lymphoproliferative Disorder in Transplanted Kidney Causing Urinary Tract Obstruction

• Park H
• Kim JS
• Kong JH
• Kim SH
• Park SW
• Song SH
• Yang JW
• Han BG
• Choi SO

• KMID: 2202628
• DOI: http://doi.org/10.4285/jkstn.2016.30.1.44

Abstract

Post-transplant lymphoproliferative disorder (PTLD) is a serious complication resulting in mortality and renal graft failure. PTLD is a heterogeneous disorder, which causes different clinical forms of disease from non-specific viral syndrome to malignant lymphoma and has various etiologies, clinical features, and treatment strategies. Here, we report on a patient who had a PTLD in the hilum of a transplanted kidney at 5 months after renal transplantation. The PTLD resulted in hydronephrosis of the transplanted kidney and graft dysfunction by local urinary tract obstruction. Despite treatment including immunosuppression reduction and rituximab administration, we removed the transplanted kidney from the recipient because the PTLD did not respond to the therapy.

Keyword

Lymphoproliferative disorders; Kidney transplantation; Hydronephrosis

MeSH Terms

Humans
Hydronephrosis
Immunosuppression
Kidney Transplantation
Kidney*
Lymphoma
Lymphoproliferative Disorders*
Mortality
Rituximab
Transplants
Urinary Tract*

Figure

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  Fig. 1. Transplanted kidney mass seen on ultrasound sonography (A) and computed tomography (B). The mass in the hilum of transplanted kidney causes hydronephrosis by local urinary tract obstruction.

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  Fig. 2. Microscopic findings of renal mass tissue obtained by fine-needle aspiration biopsy. The tissue shows proliferation of lymphoid cells including B, T, and plasma cells (A, HE stain, ×200; B, CD20, ×200; C, CD3, ×200). Epstein Barr virus in situ hybridization shows positive staining (D, ×100).

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  Fig. 3. Gross appearance of transplanted kidney removed from recipient. The tumor size is 5×4.5×4 cm in the hilum of transplanted kidney.

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  Fig. 4. Immunohistochemistry for immunoglobulin light chain of renal mass tissue. The staining both for kappa and lambda light chains shows positive, but is restricted for lambda light chain (A: kappa chain, ×100; B: lambda chain, ×100).

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