HBV vaccination and liver transplantation for hepatitis B: Winning by recruiting from within?

✍ Scribed by Michael Ishitani

• Publisher: John Wiley and Sons
• Year: 2003
• Tongue: English
• Weight: 162 KB
• Volume: 6
• Category: Article
• ISSN: 1527-6465
• DOI: 10.1002/lt.500060521

✦ Synopsis

Background: Post-transplant lymphoproliferative (PT-LPD) disorder is a life-threatening complication with an incidence of 1-10%. Uniform treatment, so far, does not exist. Methods: In December 1996, five months after a liver transplant, a 43-year-old patient developed a PT-LPD with para-aortal lymphomas and splenomegaly. Histological investigations revealed a PT-LPD of a diffuse large B-cell type of the centroblastic variant. The patient received three cycles of a modified cyclophosphamide, doxorubicin, vincristine, and prednisone regimen, resulting in complete remission, but the patient withdrew from further treatment. In February 1998, the patient had a recurrence of PT-LPD with gastric involvement and parasplenic lymphomas. The patient rejected cytotoxic treatment because of her fear of drug-induced progressive myopathy so we conducted treatment with the monoclonal antibody-directed against CD20, rituximab. Results and conclusions: After two doses of rituximab, clinical symptoms had disappeared and after six doses, gastroscopy revealed no residual disease. At this time, the patient remains in remission with a follow-up of >6 months. Anti-CD20 monoclonal antibody rituximab is a new, well-tolerated drug for the treatment of lymphomas. In addition, this drug may offer an additional treatment option for patients with PT-LPDs.