Clinical imaging and pathology analysis of Epstein-Barr virus-associated monomorphic lymphoproliferative disease after liver transplantation in children-a retrospective case series.

Background: Post-transplant lymphoproliferative disease (PTLD) is a significant complication that can arise following solid organ transplantation or hematopoietic stem cell transplantation. It encompasses a spectrum of lymphoproliferative lesions, ranging from benign reactive hyperplasia to malignant tumors, and is among the most severe complications following liver transplantation in children. It is essential for clinicians to gain a comprehensive understanding of the prevention, clinical manifestations, early diagnosis, and treatment strategies for PTLD in order to reduce mortality rates. Case Description: This study presents an analysis of six pediatric patients (three females and three males) diagnosed with monomorphic PTLD occurred at intervals of 1 month and 3 years post-transplantation. Five were localized in the gastrointestinal tract, while one was identified in the lymph nodes. The pathological diagnoses included diffuse large B-cell lymphoma (DLBCL) in three instances, Burkitt lymphoma in two, and peripheral T-cell lymphoma, not otherwise specified (PTCL-NOS) in one. Testing for Epstein-Barr virus-encoded RNA (EBER) yielded positive results in all cases. Following the reduction or cessation of immunosuppressive, antineoplastic, and anti-inflammatory medications, three patients succumbed within three months, while the remaining three patients were monitored for a duration of 6 to 13 months and remained in good condition. Conclusions: The clinical manifestations of PTLD following liver transplantation are complex. Close monitoring of serum Epstein-Barr virus (EBV) levels after transplantation, along with early diagnosis of PTLD through imaging and pathological examinations, can assist clinicians in developing individualized treatment strategies to enhance patient prognosis.