Lymphomas after solid organ transplantation:: A collaborative transplant study report
Lymphomas after solid organ transplantation:: A collaborative transplant study report
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DOI：
10.1046/j.1600-6143.2003.00325.x
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发表时间：
2004-02-01
影响因子：
8.8
通讯作者：
Döhle, B
中科院分区：
文献类型：
--
作者：
Opelz, G;Döhle, B
我们使用协作移植研究数据库分析了大约20万例器官移植受者中恶性淋巴瘤的发病率、风险和影响。在10年的时间里，肾移植受者的风险比匹配的非移植人群高11.8倍（p < 0.0001）。大多数淋巴瘤是在移植后第一年诊断出来的。在不同类型的器官移植中，心肺联合移植的相对危险度最高（RR 239.5）。在肾移植受者中，与硫唑嘌呤/类固醇治疗相比，环孢素免疫抑制并未增加风险，而FK 506治疗使风险增加约2倍。用OKT 3或ATG诱导治疗，而不是用抗IL 2受体抗体，在第一年增加了淋巴瘤的风险。OKT 3或ATG抗排斥治疗也增加了风险。肾移植和心脏移植淋巴瘤患者的第一年死亡率分别约为40%和50%，近年来未见改善。注意到移植物附近的优先定位模式，并且患者的预后与定位有关。这项研究强调了移植后淋巴瘤的持续风险，免疫抑制对风险增加的贡献，以及移植后淋巴瘤患者的持续不良结局。
We used the Collaborative Transplant Study database to analyze the incidence, risk, and impact of malignant lymphomas in approximately 200 000 organ transplant recipients. Over a 10-year period, the risk in renal transplant recipients was 11.8-fold higher than that in a matched nontransplanted population (p < 0.0001). The majority of lymphomas were diagnosed after the first post-transplant year. Heart-lung transplants showed the highest relative risk (RR 239.5) among different types of organ transplants. In kidney recipients, immunosuppression with cyclosporine did not confer added risk compared with azathioprine/steroid treatment, whereas treatment with FK506 increased the risk approximately twofold. Induction therapy with OKT3 or ATG, but not with anti-IL2 receptor antibodies, increased the risk of lymphoma during the first year. Antirejection therapy with OKT3 or ATG also increased the risk. First-year mortality in renal and heart transplant patients with lymphoma was approximately 40% and 50%, respectively, and showed no improvement in recent years. A pattern of preferential localization to the vicinity of the transplant was noted, and the prognosis of the patient was related to localization. This study highlights the continuing risk for lymphoma with time post-transplantation, the contribution of immunosuppression to increased risk, and continuing poor outcomes in patients with post-transplant lymphoma.