New developments in the diagnosis and management of posttransplantation lymphoproliferative disorders in solid organ transplant recipients.

Posttransplantation lymphoproliferative disorders (PTLDs) have emerged as important causes of morbidity and mortality in solid organ transplant recipients. Epstein-Barr virus (EBV) plays a major pathophysiologic role in the development of many, if not most, of the highly diverse disease states, which span the spectrum from infection to malignancy, encompassed by the term "PTLD." Clinical presentation and biological behavior associated with PTLD are highly variable; patients experiencing primary EBV infection in the immediate posttransplantation period are most vulnerable. New insights into PTLD pathogenesis provide exciting opportunities for rational and targeted approaches to the diagnosis, prevention, and treatment of PTLD. This article highlights some of these developments and outlines unresolved and controversial issues in PTLD management.