Post Transplantation Lymphoproliferative Disorder (PTLD) Presenting as Biliary Duct Obstruction

ABSTRACT

After adult liver transplantation (LT), post-transplant lymphoproliferative disorder (PTLD) is an uncommon but serious complication of immunosuppression (IMS) in presence of an acute or latent EBV infection. The clinical presentation of this disease is aspecific, and, after LT, it may mimic anastomotic bile duct stricture. We report the cases of 2 adult patients who developed, 3 months and 8 years after OLT, an EBV-associated PTLD with diffuse intrinsic infiltration of bile duct mimicking anastomotic biliary stricture. In the absence of liver or hilar nodes involvement, percutaneous biopsies were non contributive and the diagnosis were made by surgical biopsy. After reduction of IMS and Rituximab treatment, both patients are alive without recurrence 5 and 6 years after diagnosis. In conclusion, PTLD is one of the differential diagnosis of biliary tree obstruction after OLT. Diagnosis requires surgical biopsies and treatment consists in IMS reduction and Rituximab.