Posttransplant Lymphoproliferative Disorders in Epstein-Barr Virus Donor Positive/Recipient Negative Lung Transplant Recipients
Posttransplant Lymphoproliferative Disorders in Epstein-Barr Virus Donor Positive/Recipient Negative Lung Transplant Recipients
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DOI：
10.1016/j.athoracsur.2017.09.033
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发表时间：
2018-02-01
影响因子：
4.6
通讯作者：
Mallidi, Hari R.
中科院分区：
文献类型：
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作者：
Courtwright, Andrew M.;Burkett, Patrick;Mallidi, Hari R.
背景：eb病毒（EBV）供体阳性/受体阴性（D+/R-）状态是肺移植术后淋巴细胞增生性疾病（PTLD）的重要危险因素。然而，目前还没有研究确定EBV D+/R-肺移植人群发生PTLD的危险因素，以指导是否选择EBV阳性供者。方法：这是一项回顾性队列研究，纳入了2005年5月5日至2016年8月31日在移植受者科学登记处登记的成年人。采用Cox比例风险模型评估EBV D+/R-状态对PTLD发展的影响、PTLD对生存的影响以及EBV D+/R-和EBV D-/R-受体之间的生存差异。结果：与所有其他受体相比，EBV D+/R-组PTLD的发生率为6.2%（1,281例中有79例）和1.4%（10,352例中有145例）（校正优势比为4.0；95%可信区间：2.8至5.9,p < 0.001）。在EBV D+/R-受者中，年龄小于40岁和白种人与PTLD相关。EBV D+/R-合并PTLD的患者校正死亡风险增加（风险比1.91；95%可信区间：1.35 ~ 2.71;p < 0.001）。与EBV D+/R-受体相比，EBV D-/R-受体的调整生存率没有提高（风险比0.82；95%可信区间：0.57 ~ 1.18;p = 0.30）。结论：尽管EBV D+/R-人群的PTLD发生率和相关死亡率增加，但EBV血清阴性患者移植EBV血清阳性供者的肺与EBV血清阴性供者的肺相比，死亡率并不更低。应考虑密切监测EBV D+/R-受者的PTLD，特别是那些年龄小于40岁的白人。(C) 2018年由胸外科学会主办
Background: Epstein-Barr virus (EBV) donor positive/recipient negative (D+/R-) status is a significant risk factor for posttransplant lymphoproliferative disorder (PTLD) in lung transplant. There are, however, no studies that identify the risk factors for PTLD in the EBV D+/R- lung transplant population to guide the decision to proceed with an EBV-positive donor.Methods: This was a retrospective cohort study of adults listed in the Scientific Registry of Transplant Recipients between May 5, 2005, and August 31, 2016. Cox proportional hazards models were used to assess the impact of EBV D+/R- status on the development of PTLD, the impact of PTLD on survival, and survival differences between EBV D+/R- and EBV D-/R- recipients.Results: The incidence of PTLD was 6.2% (79 of 1,281) versus 1.4% (145 of 10,352) in EBV D+/R- versus all other recipients (adjusted odds ratio 4.0; 95% confidence interval: 2.8 to 5.9, p < 0.001). Among EBV D+/R- recipients, age less than 40 years and white race were associated with PTLD. The EBV D+/R- patients who had PTLD had increased adjusted risk of death (hazard ratio 1.91; 95% confidence interval: 1.35 to 2.71; p < 0.001). Compared with EBV D+/R- recipients, EBV D-/R- recipients did not have improved adjusted survival (hazard ratio 0.82; 95% confidence interval: 0.57 to 1.18; p = 0.30).Conclusions: Despite increased rates of PTLD and associated mortality in the EBV D+/R- population, EBV seronegative patients did not have worse mortality when transplanted with lungs from EBV seropositive donors compared with lungs from EBV seronegative donors. Consideration should be given for close monitoring for PTLD among EBV D+/R- recipients, particularly those who are white and less than 40 years of age. (C) 2018 by The Society of Thoracic Surgeons