Epidemiology of Posttransplant Lymphoproliferative Disorders in Adult Kidney and Kidney Pancreas Recipients: Report of the French Registry and Analysis of Subgroups of Lymphomas
Epidemiology of Posttransplant Lymphoproliferative Disorders in Adult Kidney and Kidney Pancreas Recipients: Report of the French Registry and Analysis of Subgroups of Lymphomas
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DOI：
10.1111/j.1600-6143.2011.03896.x
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发表时间：
2012-03-01
影响因子：
8.8
通讯作者：
Moulin, B.
中科院分区：
文献类型：
--
作者：
Caillard, S.;Lamy, F. X.;Moulin, B.
法国为所有成年肾移植受者建立了移植后淋巴增殖性疾病 (PTLD) 登记处。前瞻性入组1998年1月1日至2007年12月31日期间的PTLD病例。分析1989年1月1日后移植患者的十年累积发病率。采用Cox分析对1998年1月1日后移植患者的PTLD危险因素进行分析。 5年后累积发生率为1%，10年后累积发生率为2.1%。多变量分析显示，PTLD 与以下因素显着相关：受者年龄 4760 岁和 >60 岁（对比 3346 岁，调整后风险比 (AHR) = 1.87，CI = 1.222.86 和 AHR = 2.80，CI = 1.734.55，分别，p < 0.0001）、同步肾胰腺移植 (AHR = 2.52，CI = 1.275.01 p = 0.008），移植年份 19981999 和 20002001（分别与 20062007，AHR = 3.36，CI = 1.646.87 和 AHR = 3.08，CI = 1.556.15，p = 0.003）， EBV 不匹配（HR = 5.31，CI = 3.368.39，p < 0.001）、5 或 6 个 HLA 不匹配（相对于 04，AHR = 1.54，CI = 1.122.12，p = 0.008）和诱导治疗（AHR = 1.42，CI = 12.02，p = 0.05）。对 PTLD 亚组的分析提供了有关早期、晚期、EBV 阳性和阴性、多形性、单形性、移植物和脑淋巴瘤的 PTLD 危险因素的新信息。这项全国性研究强调了移植后长达 10 年的 PTLD 风险增加，以及辅助因子在改变 PTLD 风险中的作用，特别是在特定的 PTLD 亚组中。
A registry of posttransplant lymphoproliferative disorders (PTLD) was set up for the entire population of adult kidney transplant recipients in France. Cases of PTLD were prospectively enrolled between January 1, 1998, and December 31, 2007. Ten-year cumulative incidence was analyzed in patients transplanted after January 1, 1989. PTLD risk factors were analyzed in patients transplanted after January 1, 1998 by Cox analysis. Cumulative incidence was 1% after 5 years, 2.1% after 10 years. Multivariate analysis showed that PTLD was significantly associated with: older age of the recipient 4760 years and >60 years (vs. 3346 years, adjusted hazard ratio (AHR) = 1.87, CI = 1.222.86 and AHR = 2.80, CI = 1.734.55, respectively, p < 0.0001), simultaneous kidneypancreas transplantation (AHR = 2.52, CI = 1.275.01 p = 0.008), year of transplant 19981999 and 20002001 (vs. 20062007, AHR = 3.36, CI = 1.646.87 and AHR = 3.08, CI = 1.556.15, respectively, p = 0.003), EBV mismatch (HR = 5.31, CI = 3.368.39, p < 0.001), 5 or 6 HLA mismatches (vs. 04, AHR = 1.54, CI = 1.122.12, p = 0.008), and induction therapy (AHR = 1.42, CI = 12.02, p = 0.05). Analyses of subgroups of PTLD provided new information about PTLD risk factors for early, late, EBV positive and negative, polymorphic, monomorphic, graft and cerebral lymphomas. This nationwide study highlights the increased risk of PTLD as long as 10 years after transplantation and the role of cofactors in modifying PTLD risk, particularly in specific PTLD subgroups.