Figure 137

Posttransplantation lymphoproliferative disease (PTLD): histologic appearance of a renal allograft infiltrated by a monoclonal proliferation of B lymphocytes. Non-Hodgkin's lymphomas, of which PTLD is a variant, occur in 1% to 3% of transplant recipients and in many cases are linked to an infectious cause. PTLD can be of either polyclonal or monoclonal B-cell composition, with lymphocytes driven to proliferate by infection with the Epstein-Barr virus [11-13]. Development of PTLD is strongly linked to the intensity of immunosuppression and may regress with its reduction. However, most often in the setting of splanchnic involvement and monoclonal proliferation, as depicted, PTLD can follow a more aggressive unrelenting course despite withdrawal of immuno-suppressive therapy.

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