Post-Transplant Lymphoprolipherative Disorder (PTLD) is a condition or a reaction that happens post your liver transplantation or any kind of organ transplantation. There is a rapid increase in the immune cells or more precisely, the lymphoid cells in the body. These cells start increasing without any control. The seriousness of this growth can be harmless but sometimes, it can develop into lymph node cancer as well.

The major reason behind PTLD is the anti-rejection medicines that are taken by the patient to avoid rejection and attack by the immune system.

Types of Post-Transplant Lymphoprolipherative Disorder (PTLD)

Early lesions: This will go away by itself, if the dose of anti-rejection medicine is reduced.
Polymorphic PTLD: This is a mixture of different kinds of lymphoid cells.
Monomorphic PTLD: This is the most common type of PTLD found in many people who have undergone a liver transplantation. This has just one type of lymphoid cell.
Hodgkin Lymphoma: This is a very rare kind of PTLD.
Diagnosis of Post-Transplant Lymphoprolipherative Disorder (PTLD)

Small and painless lump under the armpit, groin, or neck area
Night sweats
High fever
Excessive weight loss
Low appetite
Unwell feeling
Usually, it is not at all easy to diagnose PTLD. The lump may grow so deep inside the body that it can be hard to see or feel it from outside. Apart from the lump, others are general symptoms and they can be a reason for any kind of infection in the body post transplantation. It can be a reaction to any new medicine taken by you or a reaction to rejection. Early diagnosis can help you in increasing the chances of a successful treatment. A biopsy is also a good way to detect PTLD, where a small piece of the liver is taken and tested under a microscope to detect PTLD.

Management of Post-Transplant Lymphoprolipherative Disorder (PTLD)
Your liver transplant surgeon is going to work closely with the lymphoma doctor in order to provide the best treatment for you. For early lesions or Polymorphic PTLD, reduction of the anti-rejection dose can give you better results. Your immune system will restore back and will destroy all the abnormal cells in the body. But it has to be done slowly so that it does not cause organ rejection again. If reduction of anti-rejection medicine is not possible or if reduction causes any kind of harm, then other treatment methods like antibody medicine such as Rituximab, or chemotherapy regimen or radiotherapy may be used.

Post-Transplant Lymphoproliferative Disorder (PTLD) - How To Diagnose It Correctly?

Improvements in medical technology and surgery techniques have made so much possible. With organ transplants becoming relatively simpler and less risky, many critical health conditions can now be resolved. Liver transplants are one of the most common and patients going through the agony of life-threatening liver diseases now have hope.

What is a Liver Transplant?

When the patient s liver is damaged to the extent that functioning is severely impaired and regeneration is not possible, a liver transplant is advised. In the transplant surgery, the diseased liver is removed and replaced by whole or part of healthy liver from the donor.

Types of Liver Transplants

Based on the type of donor, liver transplant can be classified as deceased donor and live donor transplantation.

Deceased Donor Transplants (DDLT): A "brain dead" person can be a liver donor if they had pledged their organs previously or if their relatives consent for organ donation. The healthy liver can give a new lease of life for an ailing patient.
Live Donor Liver Transplants (LDLT): A blood relative or spouse may donate a part of their liver to the patient (subject to compatibility). As the liver is a regenerative organ, the donor's liver will function normally and the recipient will have a completely new liver. At Kauvery Hospital, a detailed evaluation of the prospective donor is done to ensure that the health risks are minimized and complete recovery is achieved.
Donor Safety

Donor can lead a normal and physically active life with no restrictions. Lifelong medications are not required and women can enjoy pregnancy and motherhood.

Who Needs A Liver Transplant?

A person with end-stage liver disease is a candidate for a liver transplant. The failure can happen over a period of time or be a sudden occurrence, due medical conditions or reactions to drugs (ALF). Following are some of the common reasons for liver failure.
Alcoholism: Long term drinking can lead to end stage liver disease.
Biliary Atresia: Absence of bile ducts since birth.
Chronic viral Hepatitis: (Hepatitis B & C)
Haemochromatosis: An inherited disorder that overwhelms the body with abnormal levels of iron deposits including liver.
Liver Cancer: (Hepatocellular carcinoma) Cirrhosis increases risk of liver cancer. Transplantation early would offer potential cure.
Primary Biliary Cirrhosis: (PBC) An unusual condition with immune mediated destruction of the bile ducts resulting in failure of the liver.
Non Alcoholic SteatoHepatitis (NASH): It is a common cause of liver disease seen in those with metabolic syndrome (Obesity, Diabetes Mellitus, Hypothyroidism and Dyslipidemia with or without Hypertension). Unlike alcoholic or viral hepatitis, it occurs in people with no inherent liver problem.Primary Sclerosing Cholangitis: (PSC) The bile duct gets scarred and narrowed, which blocks bile drainage, ultimately leading to failure of the liver.
Wilson's disease: A very rare inherited disease that causes abnormal levels of copper deposition throughout the body including liver, ultimately causing liver failure.
What does a Liver Transplant Involve?

First stage: Evaluation: A team of specialists will evaluate the patient to determine if transplant is the best option or if any other course of action will be better. This includes review of the patient's medical history and a number of investigations.

If a patient is found to be a suitable candidate to undergo transplant, we proceed to the second stage where his or her name is placed on the waiting list if he or she opts for cadaveric liver transplant.

A scoring system based on medical criteria determines the priority. In general, sicker the patient, greater is the necessity for transplant.

Third stage: Donor becomes available. When a suitable donor has been identified, the patient is contacted and informed about donor's medical condition. If the patient consents, he or she will have to come to the hospital. Some basic tests will be repeated to ensure that the current condition is safe for surgery. Surgeons and anesthetists involved in the transplant will meet the patient and brief him or her about what to expect. Once all the test results are found to be satisfactory, we proceed for surgery.

 The Procedure

While aspects of the surgery vary from patient to patient, the procedure typically takes between 8 to 12 hours to complete. Once the surgery is over, the patient is shifted to the ICU where he or she will stay for 3 to 7 days. At this stage, various tubes are connected to the body to enable it to carry out its natural functions. These are gradually removed as and when deemed appropriate. From the ICU the patient is shifted to a room for 2-3 weeks. In total, patient spends about 3-4 weeks in the hospital while undergoing transplant.

Discharge & Recovery

Once the doctors deem that the patient can return home, he or she is discharged from the hospital.
A follow up schedule is given to the patient so that complete recovery is monitored. Before discharge, patient and family will be trained on how to take medicines and what precautions to take. The number of medications will reduce over time as the recovery progresses.
The pace of recovery depends upon several factors. In general, a patient may be able to resume daily activities by 1 month and resume work by about 3 months after the surgery.

The Liver Transplant Process!

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