Posttransplant Lymphoproliferative Disease (PTLD) Follow-up

Updated: Dec 23, 2020
  • Author: Phillip M Garfin, MD, PhD; Chief Editor: Ron Shapiro, MD  more...
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Further Outpatient Care

Following the Epstein-Barr virus (EBV) viral load provides useful information regarding disease status and response to treatment. Green at the University of Pittsburgh recommends weekly monitoring of EBV viral titers in the peripheral blood of patients with posttransplant lymphoproliferative disease (PTLD), [80] although for lower-risk patients the interval of monitoring may appropriately be monthly to every 3 months.

Declining viral load may suggest a response to treatment. Persistently high or rising viral load may suggest development of PTLD or disease progression. However, serial physical examinations, radiological evaluation, and assessment for any evidence of allograft rejection are essential in conjunction with EBV viral load monitoring, as some patients have wide fluctuations in blood EBV levels that do not clinically correlate with PTLD.

Management of PTLD remains a balancing act between eradication and cure of the disease and preservation of graft function. The degree of graft loss that can be tolerated depends on the graft in question. Reduction or withdrawal of immunosuppression has to be tailored accordingly, after multidisciplinary discussion, and with due consideration of other treatment options. At this time, treatment has not been standardized beyond the generally accepted belief that reduction or withdrawal of immunosuppression is initial step in PTLD management, following which the treatment is usually tailored to the specific needs of the patient.