Clinical presentation, management, and outcomes of post-transplant lymphoproliferative disorder in renal and pancreas transplantation: a 22-year experience.

Background: Post-transplant lymphoproliferative disorder (PTLD) is a life-threatening complication of solid organ transplantation associated with long-term immunosuppression and Epstein-Barr virus (EBV) reactivation. This study analyses the clinical presentation, diagnostic pathways, therapeutic strategies and outcomes of PTLD in renal and pancreatic transplant recipients at the Manchester Centre for Transplantation. Methods: A retrospective cohort study was carried out on a cohort of 73 patients diagnosed with PTLD between 2002 and 2025 following renal, simultaneous pancreas-kidney (SPK) or pancreas-only transplantation. Data were collected from electronic medical records and analysed descriptively. Clinical presentations were categorised into organ system involvement. Time from presentation to diagnosis and survival outcomes were assessed. Results: The median time from transplant to PTLD diagnosis was 132 months, with 56% of cases diagnosed more than 10 years post-transplant. Monomorphic PTLD, in particular diffuse large B-cell lymphoma (DLBCL), was the most common subtype. EBV-positivity was seen in all early cases and in 57% overall. Abdominal and B symptoms were the most frequent presentations. Bleeding and/or anaemia were significantly associated with diagnostic delay ( Conclusion: In our cohort, PTLD in transplant recipients presents with diverse symptoms and can occur several years post-transplant highlighting the need for long-term vigilance. Streamlined referral pathways and increased awareness could reduce diagnostic delays. Establishing a national PTLD registry would benefit future research.