Post-transplant lymphoproliferative disorders, Epstein-Barr virus infection, and disease in solid organ transplantation: Guidelines from the American Society of Transplantation Infectious Diseases Community of Practice
Post-transplant lymphoproliferative disorders, Epstein-Barr virus infection, and disease in solid organ transplantation: Guidelines from the American Society of Transplantation Infectious Diseases Community of Practice
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DOI：
10.1111/ctr.13652
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发表时间：
2019-07-23
影响因子：
2.1
通讯作者：
Preiksaitis, Jutta K.
中科院分区：
文献类型：
--
作者：
Allen, Upton D.;Preiksaitis, Jutta K.
这些来自美国移植传染病实践协会的最新指南回顾了实体器官移植后移植后淋巴增生性疾病（PTLD）和其他eb病毒（EBV）综合征的诊断、管理和预防。PTLD是一种以b细胞疾病为主的异质性疾病，通常是结外疾病，具有复杂而独特的病因和由病理亚型决定的可变临床表现。最近的流行病学研究报告早期ebv阳性（+）PTLD减少，晚期ebv阴性（-）PTLD增加。移植前EBV血清阴性和原发性EBV感染（通常来自供体传播感染）是EBV综合征和早期EBV + PTLD的重要危险因素。低质量的证据支持对EBV血清阴性受者的早期EBV + PTLD采取先发制人的预防策略，包括使用需要进一步结果协调的检测方法在外周血中进行EBV DNA测量，并结合干预措施降低病毒载量。减少免疫抑制（RIS）是最有效的干预措施。世卫组织组织活检病理分类仍然是PTLD诊断的金标准；最佳分期程序是不确定的。CD20(+) PTLD的治疗建议采用RIS、利妥昔单抗和细胞毒性化疗。证据差距需要未来的研究和替代治疗策略，包括免疫疗法被强调。
These updated guidelines from the American Society of Transplantation Infectious Diseases Community of Practice review the diagnosis, management, and prevention of post-transplant lymphoproliferative disorders (PTLD) and other Epstein-Barr virus (EBV) syndromes after solid organ transplantation. PTLD are a heterogeneous spectrum of predominantly B-cell disorders, often extra-nodal, with complex distinct pathogeneses and variable clinical presentations determined by pathologic subtype. Recent epidemiologic studies report a decrease in early EBV-positive (+) PTLD and an increase in late EBV-negative (-) PTLD. Pre-transplant EBV-seronegativity and primary EBV infection, often from donor-transmitted infection, are an important risk factors for EBV syndromes and early EBV + PTLD. Low-quality evidence supports preemptive prevention strategies for early EBV + PTLD in EBV-seronegative recipients that involve EBV DNA measurement in peripheral blood using assays requiring further result harmonization, combined with interventions to lower viral load. Reduction in immunosuppression (RIS) is the best validated intervention. WHO pathology classification of a tissue biopsy remains the gold standard for PTLD diagnosis; optimal staging procedures are uncertain. Treatment of CD20(+) PTLD with the response-dependent sequential use of RIS, rituximab, and cytotoxic chemotherapy is recommended. Evidence gaps requiring future research and alternate treatment strategies including immunotherapy are highlighted.