A renal transplant recipient on tacrolimus, mycophenolate mofetil, and prednisolone develops a rapidly enlarging cervical lymph node 18 months post-transplant. Biopsy confirms an EBV-associated post-transplant lymphoproliferative disorder (PTLD) — monomorphic B-cell type. First-line treatment is:

• A Emergency splenectomy
• B Reduction of immunosuppression and rituximab (anti-CD20) ✓
• C CHOP chemotherapy at full dose
• D Antiviral therapy with acyclovir alone

Explanation

PTLD management begins with reduction of immunosuppression (to restore antitumour immunity), combined with rituximab (anti-CD20 monoclonal antibody) for CD20-positive B-cell PTLD. This approach avoids excessive cytotoxic chemotherapy while leveraging immune reconstitution. Reduction of immunosuppression is balanced against the risk of graft rejection and must be closely monitored.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.