Head and Neck Posttransplant Lymphoproliferative Disorders (PTLD): A Literature Review

Abstract

Nowadays transplantation is widely used to manage end organ failure, the way that saves patient's lives and increases their survival rate. But it has some complications such as posttransplant malignancies; one of them is posttransplant lymphoproliferative disorder (PTLD). PTLD is more prevalent in children than in adults and it occurs from months to years after transplantation with the peak of 3-7 months. The incidence of PTLD after heart-lung transplantation is the most (9.4%) and after kidney transplantation is the least (1%). The common sites of PTLD involvement include abdominal region (32%), bone marrow (25%) and other sites including head and neck (43%). PTLD is related with immunosuppression caused by administration of immunosuppressive agents and is mostly accompanied by the proliferation of Epstein-Barr virus. Clinical presentation of PTLD varies from a self limiting mononucleosis to a generalized lymphoid infiltration or even a lymphoma. Management of PTLD includes reduction of immunosuppression, using anti CD20 antibody, antiviral drugs, chemothrapy and radiotherapy which are not so efficient. It's prognosis is poor and has 54% mortality rate. Clinical features of PTLD in head and neck region are cervical lymphadenopathy, generalized gingival hyperplasia with erythema, swelling, cyanotic foci and chronic mucosal ulcers; so this neccessitizes referring of a patient with such signs and symptoms or other suspicious conditions in the head and neck to a dentist for early diagnosis and biopsy. This article reviews PTLD with emphasis on oral manifestations and head and neck involvement. Key words: Lymphoproliferative Disorders, Transplantation