What is post-transplant lymphoproliferative disorder (PTLD)?
Post-transplant lymphoproliferative disorder (PTLD) refers to a group of conditions that can develop after an organ transplant (such as a kidney transplant) or a stem cell (bone marrow) transplant. A stem cell transplant replaces diseased or damaged blood cells with healthy ones.
The immune system has an important role not only in helping to fight infection, but also in protecting the body against cancer. In kidney transplant recipients, the immune system functions less well owing to the treatments that are needed to prevent rejection of the donated kidney (immunosuppression). This makes them more vulnerable to certain cancers, including PTLD.
In PTLD, white blood cells (called lymphocytes), that have a crucial role in the immune system, grow out of control, and can collect in the lymph nodes (small bean shaped structures which are part of the immune system). This can lead to lymphoma, a type of cancer. Developing PTLD after kidney transplant is uncommon, affecting around 1 in 50 kidney transplant patients in the UK, and most transplant patients do not develop it. However, there are factors which can increase the risk of developing PTLD. These include age, with children and older transplant patients at more risk, and the degree of suppression of the immune system due to anti-rejection treatment, with higher levels of suppression increasing the risk of PTLD.
PTLD is a broad term that covers several related conditions. Doctors divide them into four main types, based on how the cells look and behave:
- Early lesions, where lots of immune cells, including lymphocytes, collect in the lymph nodes. This is often treated just by decreasing the dose of anti-rejection medications.
- Polymorphic PTLD involves several different types of white blood cells which can be abnormal and cancerous, and collect in both the lymph nodes and other parts of the body such as the gut.
- Monomorphic PTLD, where collections in the lymph nodes and other body parts are made up of many similar cancerous white blood cells.
- Hodgkin’s lymphoma, a rare form of PTLD involving an abnormal cell type called Reed-Sternberg cells and affects the lymphatic system, which includes the lymph nodes.
Causes of PTLD
Epstein-Barr virus (EBV) is the most common cause of PTLD, although not all cases are related to EBV.
EBV is common, and most people will be infected in their lifetime. Some people can develop glandular fever, however for others it can be symptomless, and many people are unaware they’ve had it. After infection, the virus remains in the body, where it is in a harmless, inactive state. In immunosuppressed patients their weakened immune system can mean the virus reactivates, unfortunately this can lead to cancer.
PTLD symptoms
PTLD symptoms are often non-specific but can include:
- Fever
- Tiredness
- Lack of appetite
- Weight loss
- Night sweats
- Swelling of lymph nodes - these can be felt in areas such as the neck, armpit or groin, but are also found near deeper structures, such as organs.
PTLD diagnosis
The symptoms of PTLD can be similar to other conditions, such as infection or transplant rejection, so these are often tested for too.
Tests can include:
- Blood tests to identify any infection, inflammation, tumour markers and EBV.
- Scans, such as ultrasound or CT, to find and examine any enlarged lymph nodes.
- Bone marrow sample to look for abnormal cells.
- A biopsy of the affected part of the body. A biopsy is often the most important test because it allows doctors to look at the cells under a microscope to make a definite diagnosis.
PTLD treatments
If diagnosed early, PTLD can usually be treated successfully. Many cases of PTLD respond well to treatment, especially when found early. Treatment is tailored to each patient, balancing cancer control with protection of the transplant.
Treatments depend on the type of PTLD but can include:
Reducing anti-rejection medications
This allows the immune system to start functioning better to attack EBV and cancerous cells. This is carefully monitored by your medical team to try and avoid rejection of the kidney transplant developing.
Antibody therapy
This includes medications such as rituximab, which attach to markers on white blood cells to help the immune system recognise and kill these cells.
Chemotherapy
Chemotherapy uses certain medicines to kill cancer cells. This may be needed depending on the type of PTLD and response to other treatments.
CAR-T cell therapy
Depending on the type of PTLD and response to other treatments, some patients may be offered CAR-T cell therapy. For this, the patient’s T cells (a type of white blood cell, that play an essential role in the immune system) are engineered in a laboratory, to recognise and attack cancer cells, which are then infused back into their blood.
Useful resources for PTLD
Reviewed December 2025
"There is also an urgent need to develop new treatments for PTLD.”
Dr Heather Long
Researcher spotlight
Dr Heather Long is a researcher at the University of Birmingham looking at the relationship between the immune system, viruses and cancers.
Heather's research, made possible to The Professor Michael Nicholson research project award of £230,000, will mean she can continue her work to identify markers of PTLD in the blood of kidney transplant patients and understand more about how the tumours in PTLD behave.
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