Posttransplant Lymphoproliferative disorders in liver transplantation - A 20-year experience
Posttransplant Lymphoproliferative disorders in liver transplantation - A 20-year experience
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DOI：
10.1097/00000658-200210000-00005
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发表时间：
2002-10-01
影响因子：
9
通讯作者：
Fung, J
中科院分区：
文献类型：
--
作者：
Jain, A;Nalesnik, M;Fung, J
目的评估移植后淋巴增生性疾病（PTLD）的发病率和危险因素，以及该并发症对一个单一机构的肝移植受者大队列的生存结局的影响。摘要背景资料自1983年以来，肝移植已被接受为终末期肝病患者的治疗选择，这在很大程度上是由于非特异性定向免疫抑制的可用性和依赖性。然而，正如1968年预测和随后证实的那样，观察到某些原发恶性肿瘤的发病率增加，特别是淋巴肿瘤。虽然许多报告已经证实并澄清了PTLD的性质，但文献中充满了与PTLD.Methods4000例在1981年2月至1998年4月期间接受肝移植的连续患者，这些患者被纳入本分析，并随访至2001年11月。PTLD的分级以及与EB病毒的相关性进行比较。还对死亡原因进行了调查。治疗PTLD变化超过20年的时间，但都包括大量减少或消除基线immunosuppress.ResultsThe 1年的肝移植患者PTLD患者的生存率为85%，而整个队列的总体患者生存率为53%。精算20年生存率估计为45%。PTLD表现的总体中位时间为10个月，儿童PTLD的发病率是成人的三倍。在儿童、他克莫司免疫抑制时代移植的患者、多态性PTLD患者和局限性疾病患者中，患者生存率更好。有趣的是，Epstein-Barr病毒的存在或不存在以及PTLD呈现的时间似乎都不会影响患者的总体生存率。酒精相关性肝病移植患者有类似的PTLD的发病率，但有较高的死亡率的风险。结论虽然PTLD继续在接受肝移植的患者带来的问题，随着时间的推移，已观察到患者生存的改善。虽然现在评估预防、诊断和治疗方面的新进展的影响还为时过早，但这些方法是基于对PTLD病理生理学的更多了解。
ObjectiveTo evaluate the incidence of posttransplant lymphoproliferative disease (PTLD) and the risk factors and the impact of this complication on survival outcomes in a large cohort of liver transplant recipients at a single institution.Summary Background DataLiver transplantation has been accepted as a therapeutic option for patients with end-stage liver disease since 1983, in large part due to the availability and reliance on the use of nonspecifically directed immunosuppression. However, as predicted and subsequently verified in 1968, an increased incidence of certain de novo malignancies has been observed, particularly with regards to lymphoid neoplasms. While many reports have confirmed and clarified the nature of PTLD, the literature is fraught with conflicting experience and outcomes with PTLD.MethodsFour thousand consecutive patients who underwent liver transplants between February 1981 and April 1998 were included in this analysis and were followed to November 2001 The effect of recipient age at the time of transplant, recipient gender, diagnosis, baseline immunosuppression, grading of PTLD, and association with Epstein-Barr virus were compared. The causes of death were also examined. Treatment for PTLD varied over the 20-year period, but all included massive reduction or elimination of baseline immunosuppression.ResultsThe 1-year patient survival for liver transplant patients with PTLD was 85%, while the overall patient survival for the entire cohort was 53%. The actuarial 20-year survival was estimated at 45%. The overall median time to PTLD presentation was 10 months, and children had an incidence of PTLD that was threefold higher than adults. Patient survival was better in children, in patients transplanted in the era of tacrolimus immunosuppression, in patients with polymorphic PTLD, and in those with limited disease. Interestingly, neither the presence or absence of Epstein-Barr virus nor the timing of PTLD presentation appeared to influence overall patient survival. Patients transplanted for alcohol-related liver disease had a similar incidence of PTLD but had a higher risk of mortality.ConclusionsWhile PTLD continues to pose problems in patients receiving liver transplants, improvements in patient survival have been observed over time. While it is too early to assess the impact of new advances in prophylaxis, diagnosis, and treatment, such approaches are based on an increased knowledge of the pathophysiology of PTLD.