Description

Epstein Barr virus (EBV) remains a major infection post-transplant, often associated with and leading to the feared complication of post-transplant lymphoproliferative disorders (PTLD). The evaluation and appropriate management of EBV infections and PTLD remains controversial and is multidisciplinary, involving organ transplant professionals, infectious disease specialists, hematopathologists and oncologists. In the proposed case studies, the moderator will present 3 separate case types of a proposed expert panel that includes diverse disciplines (multiple names proposed, only a few needed). In case 1, a 5-year-old liver transplant recipient who was EBV seronegative at transplant develops a chronic high EBV peripheral blood load. The panel will discuss the management of EBV replication as it begins and then continues. The patient then has a tonsillectomy for another reason, which incidentally shows an early lesion PTLD. The panel will discuss how that changes the management. In case 2, a 35-year-old heart transplant recipient develops a central nervous system mass at 2 years post-transplant, biopsy shows a polymorphic EBV positive PTLD. The panel will discuss different diagnostic considerations and treatment regimens for CNS PTLD. In the 3rd case, a 70-year-old kidney transplant recipient develops abdominal masses at 48 months post-transplant, biopsy shows EBV negative monomorphic PTLD. The panelists will discuss the diagnosis and management of EBV negative PTLD and management in the frail elderly patient. Combined, these 3 cases will provide the audience with a wide perspective on the many issues of EBV infection patterns and PTLD therapy management. These case studies are relevant to all solid organ transplant professionals.