# Simultaneous Presentation of Post-Transplant Lymphoproliferative Disorder (PTLD) and Acute Cellular Rejection (ACR) in a Liver Transplant Recipient: A Therapeutic Conundrum

## TL;DR

A liver transplant patient developed two serious complications at the same time, requiring careful balancing of treatments to preserve the transplant and manage both conditions.

## Contribution

This case study presents a rare co-occurrence of PTLD and ACR in a liver transplant patient and highlights a successful therapeutic strategy.

## Key findings

- Early PTLD and severe ACR occurred simultaneously in a liver transplant recipient.
- Prioritizing treatment of rejection preserved allograft function and led to resolution of both conditions.
- A multidisciplinary approach was essential in managing the conflicting complications.

## Abstract

We report a 64-year-old liver transplant recipient who developed early nondestructive post-transplant lymphoproliferative disorder (PTLD) and severe acute cellular rejection (ACR) concurrently. Hepatic lymphadenopathy led to a liver biopsy demonstrating early PTLD. Immunosuppression (IS) was reduced for early PTLD, which led to acute liver injury requiring high-dose steroids. However, subsequent augmentation in immunosuppression for ACR led to progression of PTLD, requiring rituximab treatment. This case highlights the complexity of managing conflicting liver transplant complications and underscores the importance of a multidisciplinary approach. In our case, prioritizing the treatment of rejection preserved the allograft function. Long-term follow-up showed complete resolution of both rejection and PTLD.