**11. Therapy and prevention of PTLD**

Prevention of PTLD involves limiting the duration and degree of immunosuppression while still maintaining the adequacy of the donor graft. Achieving a balance of reduction in immunosuppression and preventing graft rejection or graft-versus-host disease can be challenging.

Antiviral prophylaxis may also play a role in preventing PTLD, though data are scarce, particularly in SOT recipients. The use of antivirals such as acyclovir, valganciclovir, and ganciclovir is common for HSV, CMV, and EBV prophylaxis, though utilization varies according to institutional guidelines and protocols.

Many transplant centers will preemptively reduce immunosuppression and/or administer the anti-CD20 agent rituximab when EBV reactivation (i.e., ≥1000 EBV genome equivalents per mL) has occurred in the posttransplant setting.
