Posttransplant Lymphoproliferative Disorder (PTLD) - 24 Years of Experience at a Referral Center in São Paulo, Brazil - A Retrospective Cohort Study

Sep 29, 2026

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Posttransplant lymphoproliferative disorder (PTLD) review of 38 cases among 5928 transplant recipients at a Brazilian referral center over January 2000 to June 2024. The study characterizes clinical, virological, and histopathological features alongside treatment approaches, including anti-CD20 immunotherapy, immunosuppression reduction, and first-line regimens such as R-CHOP and rituximab monotherapy. EBV DNA was detectable in 54.8% of cases, with monomorphic PTLD predominating (89.5%). Overall survival was influenced by age and treatment response, while mortality reached 42%, largely from infections and disease progression.

LanguageEnglish

CategoryResearch & Report

FormatPDF

Pages8

Reading Time20 min

AccessFree to download

Objectives

Methods

Results

Conclusions

Wiley Journal of Transplantation Volume 2025, Article ID 6468943, 8 pages [https://doi.org/10.1155/joot/6468943](https://doi.org/10.1155/joot/6468943) Research Article Posttransplant Lymphoproliferative Disorder (PTLD): 24 Years of Experience at a Referral Center in São Paulo, Brazil. Can Differences in Prevalence and Subtype of EBV Infection in the Population Influence the Results? A Retrospective Cohort Study Juliano Crdova Vargas , 1,2,3 Ricardo Helman,2 Marcelino de Souza Durão Jr.,4,5 Erika Ferraz de Arruda,4 Jos Eduardo Afonso Jr.,6 Rafael Medeiros Carraro,6 Lilian Amorim Curvelo,7 Guilherme Eduardo Gonçalves Felga,7 Celso Eduardo Lourenço Matielo,7 Patr´ıcia Holanda Almeida,7 Denise Pasqualin,8 Renata Stanzione,2 Carolina Perrone,2 Guilherme Perini,1,2 and Nelson Hamerschlak2 1 Haematology Department, Higien ´o polis Samaritan Hospital, São Paulo, São Paulo, Brazil 2 Haematology Department, Hospital Israelita Albert Einstein, São Paulo, São Paulo, Brazil 3 School of Medicine, São Camilo University Center, São Paulo, São Paulo, Brazil 4 Kidney Transplant Unit, Hospital Israelita Albert Einstein, São Paulo, São Paulo, Brazil 5 Nephrology Division, Universidade Federal de São Paulo (UNIFESP), São Paulo, São Paulo, Brazil 6 Lung Transplant Unit, Hospital Israelita Albert Einstein, São Paulo, São Paulo, Brazil 7 Hepatology Transplant Unit, Hospital Israelita Albert Einstein, São Paulo, São Paulo, Brazil 8 Pathology Department, Hospital Israelita Albert Einstein, São Paulo, São Paulo, Brazil Correspondence should be addressed to Juliano C´ordova Vargas; [julianovargas.hematologia@gmail.com](julianovargas.hematologia@gmail.com) Received 31 July 2025; Revised 5 December 2025; Accepted 11 December 2025 Academic Editor: Reut Hod-Dvorai Copyright © 2025 Juliano C´ordova Vargas et al. Journal of Transplantation published by John Wiley & Sons Ltd. Tis is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. Objectives: To retrospectively review all cases of posttransplant lymphoproliferative disorder (PTLD) in a large Brazilian transplant center, describing patients’ clinical, virological, and histopathological profles and treatment strategies and prognostic factors. Methods: Tis retrospective cohort study was conducted between January 2000 and June 2024 . Adult patients with confrmed PTLD following solid-organ or bone marrow transplant were included. Patients with other systemic cancers or on concurrent chemotherapy/radiotherapy were excluded. Clinical characteristics, PTLD prevalence, histopathology, and survival were assessed. Results: Tirty-eight cases of PTLD were identifed in the 5928 transplant patients (0.6%) . Incidence was highest in lung recipients (31%) . Median time to PTLD onset was 42 months. EBV DNA was detectable in 54.8% of cases. Monomorphic PTLD was the most common (89.5%), primarily in non-Hodgkin lymphomas (91.2%) . Immunotherapy (anti-CD20) and immunosuppression reduction were standard initial treatments. R-CHOP and rituximab monotherapy were the main frst-line regimens. Age and treatment response signifcantly infuenced overall survival. Mortality was 42%, mainly due to infections and disease progression. Conclusions: Despite the higher prevalence of EBV in Brazil, PTLD patterns and incidence were consistent with those found in developed countries. Te strong association with lung transplants mirrors global data. Local EBV subtype characteristics and host immunogenetic factors warrant further investigation. Keywords: EBV subtype; lung transplantation; posttransplant lymphoproliferative disorder; PTLD 2 Journal of Transplantation 1. Introduction data being retrieved from medical records and used in this study. For patients who were no longer being followed up at Posttransplant lymphoproliferative disorders (PTLDs) are the insti

FAQs

What patient population and timeframe were included in the retrospective cohort study?

Adult patients with confirmed PTLD diagnosed between January 1, 2000 and June 1, 2024 were included. The study used consecutive admissions during the period and extracted data from medical records.

How common was PTLD and what was the highest-incidence transplant group?

PTLD occurred in 38 of 5928 transplant patients (0.6%). Incidence was highest among lung transplant recipients at 31%.

What were the key virological and histopathological findings, and which treatments were used initially?

EBV DNA was detectable in 54.8% of cases, and monomorphic PTLD was most common (89.5%), with primarily non-Hodgkin lymphomas. Initial standard treatments included anti-CD20 immunotherapy and reduction of immunosuppression, with R-CHOP and rituximab monotherapy as main first-line regimens.

Sep 29, 2026

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