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Post-transplant lymphoproliferative disease in liver transplantation

¹ Radiology Department, ² Liver Unit, University Hospital Birmingham, Birmingham, UK

View larger version (10K): [in this window] [in a new window]   Figure 1. Comparison of age at transplantationvs time interval to PTLD vs primary pathology (Spearman's rank correlation test – p>0.5). PBC, primary biliary cirrhosis; Hep C, hepatitis C cirrhosis; Hep B, hepatitis B cirrhosis; NonA/B, non A/B hepatitis cirrhosis; Scl Ch, sclerosing cholangitis.

View larger version (98K): [in this window] [in a new window]   Figure 2. Allograft involvement– 6 years post-transplant for primary biliary cirrhosis. (a) Abnormal ultrasound of liver allograft identified multiple hypoechoic parenchymal lesions. (b) CT confirmed multiple low attenuation lesions within the liver and the presence of ascites. (c) Concurrent pleural effusions and lung collapse noted. Final diagnosis – B-cell non-Hodgkin's lymphoma; the patient is still alive 2 years post-chemotherapy.

View larger version (81K): [in this window] [in a new window]   Figure 3. Portal mass– patient presented with obstructive jaundice 5 months post-transplant for primary biliary cirrhosis. (a) Ultrasound identified the presence of a portal hilar mass confirmed on CT. (b) CT – note the distortion of the portal vein (arrow) and the intrahepatic duct dilatation (broken arrow). Final diagnosis – non-Hodgkin's lymphoma. Tumour responded after several cycles of chemotherapy and one of radiotherapy. The patient is alive 5 years post-treatment.

View larger version (127K): [in this window] [in a new window]   Figure 4. Portal stricture– patient presented 11 months post-transplant for hepatitis C cirrhosis. (a) CT identifies low attenuation area around porta hepatitis causing stricturing. (b) Confirmed at endoscopic retrograde cholangiopancreatography. (c) Second CT image post stent placement after 1 month; notice the increase in size of the mass. Final diagnosis: B-cell lymphoma; treated with re-transplantation. The patient is still alive 4 years later.

View larger version (119K): [in this window] [in a new window]   Figure 5. Small bowel involvement: barium follow-through for a patient 3 years post-transplant for hepatitis C cirrhosis presenting with small bowel obstruction with an extensive stricture within the terminal ileum which was resected. Final diagnosis: Burkitt's lymphoma; treated further with chemotherapy. Patient is still alive 9 years post-treatment.

View larger version (131K): [in this window] [in a new window]   Figure 6. Cerebral mass 5.5 years post-transplant for hepatitis C cirrhosis, patient presented with increasing confusion and signs of raised intracranial pressure. CT head identified a deep right frontal space-occupying lesion demonstrating marked surrounding oedema. The tumour bled post biopsy (arrow) and the patient died within 2 weeks of the biopsy. Final diagnosis was lymphoma.