PRETRANSPLANTATION ASSESSMENT OF THE RISK OF LYMPHOPROLIFERATIVE DISORDER
PRETRANSPLANTATION ASSESSMENT OF THE RISK OF LYMPHOPROLIFERATIVE DISORDER
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DOI：
10.1093/clinids/20.5.1346
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发表时间：
1995-05-01
影响因子：
11.8
通讯作者：
PAYA, CV
中科院分区：
文献类型：
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作者：
WALKER, RC;MARSHALL, WF;PAYA, CV
移植后淋巴组织增生性疾病（PTLD）是一种罕见的，但往往是致命的并发症的实体器官移植，发生在约3%的患者。确定移植前PTLD潜在危险因素的相对重要性和关系（即，受体的EB病毒[EBV]血清状态和受体和潜在供体的巨细胞病毒[CMV]血清状态）和移植后的主要危险因素（抗淋巴细胞抗体免疫抑制），我们分析了在马约诊所就诊的前381例连续成人非肾移植受体的结果。在没有其他危险因素的情况下，EBV血清阴性受者PTLD的发生率比EBV血清阳性受者高24倍（95%置信区间[CI]：6.2，89）。用OKT 3治疗排斥反应和CMV血清不匹配的其他风险因素（即，阴性受体和阳性供体）各自进一步将这种风险放大了四到六倍。与不存在这些风险因素时的低发病率（0.458例/100人年）相比，所有三种风险因素协同作用，使致死性和/或CNS PTLD的发病率增加654倍（CI：368，1，162）。移植前确定受体EBV和CMV血清状态可以识别出一个亚组的患者，其严重PTLD的风险可能会妨碍移植。
Posttransplantation lymphoproliferative disorder (PTLD) is an uncommon but often fatal complication of solid organ transplantation that occurs in similar to 3% of patients. To determine the relative importance and relationship of potential risk factors for PTLD before transplantation (i.e., Epstein-Barr virus [EBV] serostatus of the recipient and the cytomegalovirus [CMV] serostatus of the recipient and the potential donor) and the principal risk factor after transplantation (immunosuppression with antilymphocyte antibody), we analyzed the findings for the first 381 consecutive adult nonrenal transplant recipients seen at Mayo Clinic. In the absence of other risk factors, the incidence rate of PTLD for EBV-seronegative recipients was 24 times higher (95% confidence interval [CI]: 6.2, 89) than that for EBV-seropositive recipients. The additional risk factors of therapy with OKT3 for rejection and CMV seromismatch (i.e., a negative recipient and a positive donor) each further amplified this risk four- to sixfold. Together, all three risk factors acted synergistically to increase the incidence rate of fatal and/or CNS PTLD by a factor of 654 (CI: 368, 1,162) compared with the low incidence rate (.458 cases per 100 person years) when none of these risk factors were present. Pretransplantation determination of recipient EBV and CMV serostatus can identify a subgroup of patients whose risk for severe PTLD may preclude transplantation.