Post-Transplant Lymphoproliferative Disorder (PTLD)

Post-transplant lymphoproliferative disorder (PTLD) is a rare but serious condition in which white blood cells called lymphocytes multiply uncontrollably after an organ transplant. In severe cases, PTLD can lead to a type of blood cancer affecting the lymph nodes, known as lymphoma. 

At UPMC, our experts will closely monitor your condition after your transplant and look for early signs of complications. If you are diagnosed with PTLD, our team follows evidence-based treatment protocols to give you the best chance of a successful outcome.

---

Looking for PTLD Care?

Related services include:

---

On this page

• What Is PTLD?
• What Are the Symptoms of PTLD?
• How Do You Diagnose PTLD?
• How Do You Treat PTLD?

What Is PTLD?

Post-transplant lymphoproliferative disorder (PTLD) is a rare but serious condition that occurs when white blood cells called lymphocytes multiply uncontrollably after an organ transplant. In severe cases, PTLD can cause a type of blood cancer that affects the lymph nodes called lymphoma.

What are the types of PTLD? 

There are four types of PTLD, including:

• Early lesion — Causes symptoms of fatigue, sore throat, fever, headache, and swollen lymph nodes similar to Epstein-Barr virus (EBV), also known as mononucleosis.
• Classic Hodgkin lymphoma – PTLD type — A rare type of PTLD, which causes cells that look like classic Hodgkin lymphoma cells.
• Monomorphic PTLD — The most common type of PTLD, this causes lymphoma cells that look like non-Hodgkin lymphoma cells.
• Polymorphic PTLD — Lymphoma cells are mixed in with normal lymphocytes and other cells.

How common is PTLD?

PTLD is a rare but serious complication after a transplant. The percentage of people affected varies by the type of organ transplant performed.

What causes PTLD?

PTLD that occurs within a few years of a transplant is caused by Epstein-Barr virus (EBV), also known as mononucleosis. Medications you take after your transplant to prevent your immune system from attacking your new organ can weaken your immune system.

Your weakened immune system increases your risk of infection and may allow common childhood viruses like EBV, which stays inactive in your body, to become active again. When EBV reactivates, it causes lymphocytes to multiply, leading to PTLD. 

Researchers are unsure what causes PTLD to develop years after a transplant.

What are PTLD risk factors and complications?

PTLD risk factors

You may be at higher risk of developing PTLD if:

• You are taking immunosuppressant medications after your transplant.
• You have a genetic condition that makes you more likely to develop PTLD.
• You have EBV.
• Your donor has EBV.

Complications of PTLD

PTLD can cause complications, including:

• Enlarged lymph nodes.
• Lymphoma.
• Organ damage.

How can I prevent PTLD? 

There is nothing you can do to prevent PTLD. However, early diagnosis of PTLD can increase the chances of a successful treatment outcome.

Back to top

---

What Are the Signs and Symptoms of PTLD?

PTLD symptoms may include:

• Fatigue.
• Fever.
• Night sweats.
• Poor appetite.
• Swollen lymph nodes.
• Unintentional weight loss.

When should I see a doctor about my PTLD symptoms?

If you have symptoms of PTLD, you should schedule an appointment with your doctor right away.

Back to top

---

How Do You Diagnose PTLD?

To diagnose PTLD, your doctor will perform a physical exam, ask about your medical history, and order tests.

What to expect during your visit

If your doctor suspects PTLD, they will:

• Ask about your symptoms.
• Perform a physical exam.
• Order tests.
• Review your health history and medications.

Tests to diagnose PTLD

Tests to diagnose PTLD may include:

• Biopsy — involves taking a small sample of organ tissue to check for problems.
• Blood tests — Common blood tests include a complete blood count (CBC), comprehensive metabolic panel, lactate dehydrogenase (LDH), and an EBV antibody test.
• Imaging tests — Your doctor may order CT, MRI, or PET scans to look at organs or tissues inside your body.
• Urine tests — Your doctor may order urine tests to check how well your kidneys or liver are working.

PTLD prognosis

Your prognosis after a PTLD diagnosis depends on your overall health, the severity of your condition, how you respond to treatment, and other factors. Your doctor will discuss your prognosis with you.

Back to top

---

How Do You Treat PTLD?

Your treatment for PTLD will depend on the type of PTLD you have and your overall health. Treatment options may include:

Reducing your dose of immunosuppressant medications

Your doctor may reduce your dosage of immunosuppressant medications to help your immune system fight infections more effectively. However, this needs to be done carefully under the supervision of your doctor to reduce the risk of organ rejection.

Medical oncology treatments

If your PTLD causes lymphoma, your doctor may recommend medical oncology treatments such as chemotherapy or immunotherapy to treat cancer cells.

Radiation therapy

Your doctor may recommend radiation therapy to target abnormal cells in specific areas of your body.

Surgery

In rare cases, your doctor may recommend surgery to remove organs or tissue affected by PTLD.

Back to top

---

Why Choose UPMC for PTLD Care?

When you choose UPMC for PTLD care, you will receive:

• Access to board-certified specialists — Our organ transplantation specialists take steps to reduce the risk of transplant-related complications and provide expert follow-up care to monitor your condition.
• Expert diagnosis and personalized care — Our team will develop a customized treatment plan to reduce your risk of complications and improve your quality of life.
• A full range of treatment options —From immunosuppressive medication management to palliative care, we offer a full range of treatment options for people who have had an organ transplant.

Back to top

---

By UPMC Editorial Staff. Last reviewed on 2025-12-09.