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Post-transplant indolent T cell lymphoproliferative disorder in living donor liver transplantation : a case report

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Title: Post-transplant indolent T cell lymphoproliferative disorder in living donor liver transplantation : a case report
Authors: Goto, Ryoichi Browse this author →KAKEN DB
Kawamura, Norio Browse this author →KAKEN DB
Watanabe, Masaaki Browse this author →KAKEN DB
Koshizuka, Yasuyuki Browse this author
Shiratori, Souichi Browse this author →KAKEN DB
Ara, Momoko Browse this author →KAKEN DB
Honda, Shohei Browse this author →KAKEN DB
Mitsuhashi, Tomoko Browse this author →KAKEN DB
Matsuno, Yoshihiro Browse this author →KAKEN DB
Shimamura, Tsuyoshi Browse this author →KAKEN DB
Taketomi, Akinobu Browse this author →KAKEN DB
Keywords: Indolent T cell lymphoproliferative disorder
Post-transplant lymphoproliferative disorder
Living donor liver transplantation
Issue Date: 26-Jun-2020
Publisher: Springer
Journal Title: Surgical case reports
Volume: 6
Issue: 1
Start Page: 147
Publisher DOI: 10.1186/s40792-020-00904-y
Abstract: Background Post-transplant lymphoproliferative disorder (PTLD) of T cell type has been rarely reported. Accurate diagnosis of this life-threatening rare form of PTLD is important for the treatment strategy. Case presentation A 7-year-old boy had severe diarrhea and weight loss progressively at 7 years post-living donor liver transplantation (LDLT) for biliary atresia. Endoscopy in the gastrointestinal (GI) tract revealed multiple erosions and ulcer lesions with prominent intraepithelial lymphocytosis in the duodenum and terminal ileum. Immunohistochemical examination demonstrated that these accumulated lymphocytes mainly comprised small- to medium-sized T cells expressing CD3, CD4, CD5, CD7, and CD103, but lacking CD8, CD56, and Epstein-Barr virus-encoded small RNAs. In addition, T cell receptor beta gene rearrangement was detected by polymerase chain reaction analysis. Comprehensively, the lesions were best interpreted as post-transplant indolent T cell lymphoproliferative disorder (LPD) of the intestine. Clinical remission was achieved by reducing the immunosuppressant. Conclusion A rarely reported indolent type of T cell LPD in post-LDLT was diagnosed by direct inspection and histological investigation. Although the histological classification and therapeutic strategy for post-transplant indolent T cell LPD have not been established, reducing immunosuppression allowed complete remission in our case. To prevent the incidence of PTLD and de novo malignancy, developing a methodology to set a proper dose of immunosuppressant is required.
Type: article
Appears in Collections:医学院・医学研究院 (Graduate School of Medicine / Faculty of Medicine) > 雑誌発表論文等 (Peer-reviewed Journal Articles, etc)

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