Archivos suplementarios
Palabras clave
trastornos linfoproliferativos
trasplante renal
tituximab
virus Epstein Barr.
trasplante renal
tituximab
virus Epstein Barr.
Cómo citar
1.
Rodríguez Sánchez MP, García Padilla PK, Contreras KM, González González CA, Puentes S. Enfermedad linfoproliferativa en el injerto renal. Reporte de un caso y revisión de la literatura. Rev. Colomb. Nefrol. [Internet]. 27 de julio de 2017 [citado 3 de julio de 2024];4(2):210-6. Disponible en: https://revistanefrologia.org/index.php/rcn/article/view/218
Resumen
Los desórdenes linfoproliferativos postrasplante (PTLD por sus siglas en inglés: Posttransplant Lymphoproliferative disorders) se presentan en 3 a 10% de adultos con trasplante de órgano sólido (TOS). Se ha asociado a infección por Virus Epstein Barr (VEB). Es difícil diferenciar PTLD de rechazo o infección viral, porque los hallazgos clínicos e histopatológicos son muy similares. Presentamos el caso de un paciente con enfermedad renal crónica (ERC) secundaria a glomerulonefritis IgM, con trasplante renal de donante cadavérico, quien presentó proteinuria y disminucuón de la función renal, se le documentó una masa en el injerto renal compatible con desorden linfoproliferativo postrasplante renal de tipo polimórfico (PTLD), VEB positivo y CD 20 positivo. El tratamiento consistió en rituximab 375 mg/m2 semanales, cuatro dosis, se realizó control con imágenes y se adicionó el esquema CHOP (ciclofosfamida, vincristina, doxorubicina). El paciente toleró de manera adecuada la quimioterapia, no requirió radioterapia, ni trasplantectomía y después del R-CHOP la masa disminuyó de manera significativa hasta desaparecer al año de seguimiento manteniendo función óptima del injerto renal.
Citas
1. Jagadeesh D, Woda BA, Draper J, Evens AM. Post transplant lymphoproliferative disorders: Risk, classification, and therapeutic recommendations. Curr Treat Options Oncol. 2012;13(1):122-36. Disponible en: https:doi.org/10.1007/s11864-011-0177-x
2. Caillard S, Lamy FX, Quelen C, et al. Epidemiology of posttransplant lymphoproliferative disorders in adult kidney and kidney pancreas recipients: Report of the French registry and analysis of subgroups of lymphomas. Am J Transplant. 2012;12(3):682-93. Disponible en: https://doi.org/10.1111/j.1600-6143.2011.03896.x
3. Petrara MR, Giunco S, Serraino D, Dolcetti R, De Rossi A. Post-transplant lymphoproliferative disorders: From epidemiology to pathogenesis-driven treatment. Cancer Lett. 2015;369(1):37-44. Disponible en: https://doi.org/10.1016/j.canlet.2015.08.007
4. Tse E, Kwong Y-L. Epstein Barr virus-associated lymphoproliferative diseases: the virus as a therapeutic target. Exp Mol Med. 2015;47(1):e136. Disponible en: https://doi.org/10.1038/emm.2014.102
5. Yoon J-H, Lee S, Kim H-J, et al. Comparative analysis of post-transplant lymphoproliferative disorder after kidney transplantation versus hematopoietic stem cell transplantation. Transpl Int. 2014;27(7):721-32. Disponible en: https://doi.org/10.1111/tri.12328
6. Taylor AL, Marcus R, Bradley JA. Post-transplant lymphoproliferative disorders (PTLD) after solid organ transplantation. Crit Rev Oncol Hematol. 2005;56(1 Spec No):155-67. doi:10.1016/j.critrevonc.2005.03.015
7. Morton M, Coupes B, Roberts SA, et al. Epidemiology of posttransplantation lymphoproliferative disorder in adult renal transplant recipients. Transplantation. 2013;95(3):470-8. Disponible en: https://doi.org/10.1097/TP.0b013e318276a237
8. Jha B, Mohan N, Gajendra S, et al. Prompt diagnosis and management of Epstein-Barr virus-associated post-transplant lymphoproliferative disorder and hemophagocytosis: A dreaded complication in a post-liver transplant child. Pediatr Transplant. 2015;19(7):E177-80. Disponible en: https://doi.org/10.1111/petr.12558
9. Dierickx D, Tousseyn T, Gheysens O. How I treat posttransplant lymphoproliferative disorders. Blood. 2015;126(20):2274-83. https://doi.org/10.1182/blood-2015-05-615872
10. Singavi AK, Harrington AM, Fenske TS. Post-transplant lymphoproliferative disorders. Cancer Treat Res. 2015;165:305-27. https://doi.org/10.1007/978-3-319-13150-4_13
11. Foran JM, Norton AJ, Micallef INM, et al. Loss of CD20 expression following treatment with rituximab (chimaeric monoclonal anti-CD20): A retrospective cohort analysis. Br J Haematol. 2001;114(4):881-3. Disponible en: https://doi.org/10.1046/j.1365-2141.2001.03019.x
12. Parker A, Bowles K, Bradley JA, et al. Management of post-transplant lymphoproliferative disorder in adult solid organ transplant recipients - BCSH and BTS Guidelines. Br J Haematol. 2010;149(5):693-705. Disponible en: https://doi.org/10.1111/j.1365-2141.2010.08160.x
13. Birkeland S a, Andersen HK, Hamilton-Dutoit SJ. Preventing acute rejection, Epstein-Barr virus infection, and posttransplant lymphoproliferative disorders after kidney transplantation: use of aciclovir and mycophenolate mofetil in a steroid-free immunosuppressive
protocol. Transplantation. 1999;67(9):1209-14. https://doi.org/10.109700007890-199905150-00002
14. Caillard S, Dharnidharka V, Agodoa L, Bohen E, Abbott K. Posttransplant lymphoproliferative disorders after renal transplantation in the United States in era of modern immunosuppression. Transplantation. 2005;80(9):1233-43. Disponible en: https://doi.org/10.1097/01.tp.0000179639.98338.39
15. Elstrom RL, Andreadis C, Aqui NA, et al. Treatment of PTLD with rituximab or chemotherapy. Am J Transplant. 2006;6(3):569-76. Disponible en: https://doi.org/10.1111/j.1600-6143.2005.01211.x
16. Tsai DE, Hardy CL, Tomaszewski JE, et al. Reduction in immunosuppression as initial therapy for posttransplant lymphoproliferative disorder: analysis of prognostic variables and longerm follow-up of 42 adult patients. Transplantation. 2001;71(8):1076-88. Disponible en: https://doi.org/10.109700007890-200104270-00012
17. Buell JF, Gross TG, Hanaway MJ, et al. Chemotherapy for posttransplant lymphoproliferative disorder: The Israel Penn International Transplant Tumor Registry Experience. Transplantation Proceedings. 2005;37(2):956-7. Disponible en: https://doi.org/10.1016/j.transproceed.2004.12.124
2. Caillard S, Lamy FX, Quelen C, et al. Epidemiology of posttransplant lymphoproliferative disorders in adult kidney and kidney pancreas recipients: Report of the French registry and analysis of subgroups of lymphomas. Am J Transplant. 2012;12(3):682-93. Disponible en: https://doi.org/10.1111/j.1600-6143.2011.03896.x
3. Petrara MR, Giunco S, Serraino D, Dolcetti R, De Rossi A. Post-transplant lymphoproliferative disorders: From epidemiology to pathogenesis-driven treatment. Cancer Lett. 2015;369(1):37-44. Disponible en: https://doi.org/10.1016/j.canlet.2015.08.007
4. Tse E, Kwong Y-L. Epstein Barr virus-associated lymphoproliferative diseases: the virus as a therapeutic target. Exp Mol Med. 2015;47(1):e136. Disponible en: https://doi.org/10.1038/emm.2014.102
5. Yoon J-H, Lee S, Kim H-J, et al. Comparative analysis of post-transplant lymphoproliferative disorder after kidney transplantation versus hematopoietic stem cell transplantation. Transpl Int. 2014;27(7):721-32. Disponible en: https://doi.org/10.1111/tri.12328
6. Taylor AL, Marcus R, Bradley JA. Post-transplant lymphoproliferative disorders (PTLD) after solid organ transplantation. Crit Rev Oncol Hematol. 2005;56(1 Spec No):155-67. doi:10.1016/j.critrevonc.2005.03.015
7. Morton M, Coupes B, Roberts SA, et al. Epidemiology of posttransplantation lymphoproliferative disorder in adult renal transplant recipients. Transplantation. 2013;95(3):470-8. Disponible en: https://doi.org/10.1097/TP.0b013e318276a237
8. Jha B, Mohan N, Gajendra S, et al. Prompt diagnosis and management of Epstein-Barr virus-associated post-transplant lymphoproliferative disorder and hemophagocytosis: A dreaded complication in a post-liver transplant child. Pediatr Transplant. 2015;19(7):E177-80. Disponible en: https://doi.org/10.1111/petr.12558
9. Dierickx D, Tousseyn T, Gheysens O. How I treat posttransplant lymphoproliferative disorders. Blood. 2015;126(20):2274-83. https://doi.org/10.1182/blood-2015-05-615872
10. Singavi AK, Harrington AM, Fenske TS. Post-transplant lymphoproliferative disorders. Cancer Treat Res. 2015;165:305-27. https://doi.org/10.1007/978-3-319-13150-4_13
11. Foran JM, Norton AJ, Micallef INM, et al. Loss of CD20 expression following treatment with rituximab (chimaeric monoclonal anti-CD20): A retrospective cohort analysis. Br J Haematol. 2001;114(4):881-3. Disponible en: https://doi.org/10.1046/j.1365-2141.2001.03019.x
12. Parker A, Bowles K, Bradley JA, et al. Management of post-transplant lymphoproliferative disorder in adult solid organ transplant recipients - BCSH and BTS Guidelines. Br J Haematol. 2010;149(5):693-705. Disponible en: https://doi.org/10.1111/j.1365-2141.2010.08160.x
13. Birkeland S a, Andersen HK, Hamilton-Dutoit SJ. Preventing acute rejection, Epstein-Barr virus infection, and posttransplant lymphoproliferative disorders after kidney transplantation: use of aciclovir and mycophenolate mofetil in a steroid-free immunosuppressive
protocol. Transplantation. 1999;67(9):1209-14. https://doi.org/10.109700007890-199905150-00002
14. Caillard S, Dharnidharka V, Agodoa L, Bohen E, Abbott K. Posttransplant lymphoproliferative disorders after renal transplantation in the United States in era of modern immunosuppression. Transplantation. 2005;80(9):1233-43. Disponible en: https://doi.org/10.1097/01.tp.0000179639.98338.39
15. Elstrom RL, Andreadis C, Aqui NA, et al. Treatment of PTLD with rituximab or chemotherapy. Am J Transplant. 2006;6(3):569-76. Disponible en: https://doi.org/10.1111/j.1600-6143.2005.01211.x
16. Tsai DE, Hardy CL, Tomaszewski JE, et al. Reduction in immunosuppression as initial therapy for posttransplant lymphoproliferative disorder: analysis of prognostic variables and longerm follow-up of 42 adult patients. Transplantation. 2001;71(8):1076-88. Disponible en: https://doi.org/10.109700007890-200104270-00012
17. Buell JF, Gross TG, Hanaway MJ, et al. Chemotherapy for posttransplant lymphoproliferative disorder: The Israel Penn International Transplant Tumor Registry Experience. Transplantation Proceedings. 2005;37(2):956-7. Disponible en: https://doi.org/10.1016/j.transproceed.2004.12.124
- Los autores/as conservarán sus derechos de autor y garantizarán a la revista el derecho de primera publicación de su obra, el cuál estará simultáneamente sujeto a la Licencia de Creative Commons Reconocimiento- NoComercial- SinObraDerivada 4.0 Internacional. que permite a terceros compartir la obra siempre que se indique su autor y su primera publicación esta revista.