Post-transplant lymphoproliferative disorder after lung transplantation: A review of 35 cases
Post-transplant lymphoproliferative disorder after lung transplantation: A review of 35 cases
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DOI：
10.1016/j.healun.2011.10.013
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发表时间：
2012-03-01
影响因子：
8.9
通讯作者：
Tsai, Donald E.
中科院分区：
文献类型：
--
作者：
Kremer, Brandon E.;Reshef, Ran;Tsai, Donald E.
背景：移植后淋巴增殖性疾病（PTLD）是器官移植的并发症。发生 PTLD 的风险因多种因素而异，包括移植的器官和使用的免疫抑制程度。 方法：我们对在我们中心接受肺移植后治疗的 35 例 PTLD 患者进行回顾性分析。在 705 名接受同种异体移植的患者中，34 名 (4.8%) 出现 PTLD。一名患者在其他地方接受移植并在我们中心接受治疗。结果：49% 的患者 PTLD 涉及同种异体移植物，23% 的患者涉及胃肠道 (GI) 管腔。组织学上，39%的肿瘤是单形性的，48%是多形性的。发病时间决定了疾病的位置和组织学。在移植后 11 个月内诊断出的 17 名患者中，12 名患者 (71%) 涉及同种异体移植物，1 名患者涉及胃肠道 (p = 0.01)。这种“早期”PTLD 具有 85% 的多态性 (p = 0.006)。相反，在移植后超过 11 个月诊断的 18 名患者中，5 名患者 (28%) 累及肺部，7 名患者 (39%；p = 0.01) 累及胃肠道。 “晚期”PTLD 为 71% 单态性 (p = 0.006)。诊断后的中位总生存期为 18.57 个月。所有肺移植受者和发生 PTLD 的患者的总生存率没有差异。结论：PTLD 是肺移植后一种罕见的并发症，在现代免疫抑制时代，其发病率显着下降。我们报告了对肺移植后 PTLD 的易感性、进展和治疗很重要的几个因素。 J Heart Lung Transplant 2012；31:296-304 (C) 2012 国际心肺移植学会。版权所有。
BACKGROUND: Post-transplant lymphoproliferative disorder (PTLD) is a complication of organ transplantation. The risk of developing PTLD varies depending on a number of factors, including the organ transplanted and the degree of immunosuppression used.METHODS: We report a retrospective analysis of 35 patients with PTLD treated at our center after lung transplantation. Of 705 patients who received allografts, 34 (4.8%) developed PTLD. One patient underwent transplantation elsewhere and was treated at our center.RESULTS: PTLD involved the allograft in 49% of our patients and the gastrointestinal (GI) tract lumen in 23%. Histologically, 39% of tumors were monomorphic and 48% polymorphic. The time to presentation defined the location and histology of disease. Of 17 patients diagnosed within 11 months of transplantation, PTLD involved the allograft in 12 (71%) and the GI tract in 1 (p = 0.01). This "early" PTLD was 85% polymorphic (p = 0.006). Conversely, of the 18 patients diagnosed more than 11 months after transplant, the lung was involved in 5 (28%) and the GI tract in 7 (39%; p = 0.01). "Late" PTLD was 71% monomorphic (p = 0.006). Median overall survival after diagnosis was 18.57 months. Overall survival did not differ between all lung transplant recipients and those who developed PTLD.CONCLUSIONS: PTLD is an uncommon complication after lung transplantation, and its incidence declined remarkably in the era of modern immunosuppression. We report several factors that are important for predisposition toward, progression of, and treatment of PTLD after lung transplantation. J Heart Lung Transplant 2012;31:296-304 (C) 2012 International Society for Heart and Lung Transplantation. All rights reserved.