A lung transplant recipient with posttransplant lymphoproliferative disorder successfully treated with rituximab

Abstract

Posttransplant lymphoproliferative disorder (PTLD) is a life-threatening complication after lung transplantation. This report describes the first case of PTLD in Japanese lung transplant recipients, which was successfully treated with rituximab. A 38-year-old man with emphysema underwent double lung transplantation and developed polymorphic PTLD in the allografts 4 months later. Immunosuppression therapy was reduced and immunoglobulin and antiviral drugs were administered. This therapy was not effective and resulted in acute rejection managed with steroid pulse therapy. We subsequently treated the patient using rituximab, an anti-CD20 monoclonal antibody. Thereafter, the lesions in both lungs regressed slightly, but remained present. Positron emission tomography with fluoro-2-deoxy-D-glucose (FDG-PET) showed no uptake in the thoracic fields, so we did not give the patient further courses of rituximab. One year after the diagnosis of PTLD, the nodules had almost completely disappeared and the patient presented no evidence of recurrence now.