Primary Epstein-Barr virus infection, seroconversion, and post-transplant lymphoproliferative disorder in seronegative renal allograft recipients: a prospective cohort study
Primary Epstein-Barr virus infection, seroconversion, and post-transplant lymphoproliferative disorder in seronegative renal allograft recipients: a prospective cohort study
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DOI：
10.1111/tid.12533
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发表时间：
2016-06-01
影响因子：
2.6
通讯作者：
House, A. A.
中科院分区：
文献类型：
--
作者：
Hosseini-Moghaddam, S. M.;Alhomayeed, B.;House, A. A.
背景EB病毒（EBV）血清阴性的肾移植受者有发生移植后淋巴组织增生性疾病（PTLD）的危险。我们比较了原发性EBV感染，血清转换，和PTLD的EBV血清阴性患者接受肾移植从血清阳性或血清阴性供体（D+/R-和D-/R-，分别）。我们随访患者从1999年1月至2009年6月的临床访问，每月EB病毒聚合酶链反应试验，血清学试验为一个为期1年的肾移植后，并在个人的基础上afterthors.Results3例（9%）发展PTLD，包括2早发性（12个月）疾病。在D+/R-和D-/R-患者中，PTLD（8% vs. 12.5%，P = 0.7）、EBV血清转换（64% vs. 50%，P = 0.4）和EBV病毒血症（40% vs. 25%，P = 0.6）的频率无显著差异。临床、血清学和病毒学监测以及原发性EBV感染后免疫抑制的减少导致PTLD率为9%，尽管血清转换率为60.6%。减少免疫抑制后的移植物丢失率为10%（20例中的2例），与13例无EBV血清转换的患者（无移植物丢失，P = 0.5）无显著差异。病毒血症，血清转换，和PTLD在D+/R-和D-/R- patients.ConclusionsThe肾移植PTLD的发病率范围从0.5%到2.9%的比率似乎是相似的。我们的数据显示，在EBV血清阴性的肾移植受者中，发生率明显较高，这表明需要密切监测。我们的数据还表明，无论血清学状态是阳性还是阴性，都可以接受EBV血清阴性受体的供体，在任何情况下都需要进行持续的监测。
BackgroundEpstein-Barr virus (EBV)-seronegative renal transplant recipients are at risk of post-transplant lymphoproliferative disorder (PTLD). We compared primary EBV infection, seroconversion, and PTLD in EBV-seronegative patients who received renal allograft from seropositive or seronegative donors (D+/R- and D-/R-, respectively).MethodsWe prospectively followed 25 D+/R- and 8 D-/R- recipients. We followed patients from January 1999 to June 2009 with clinical visits, monthly EBV polymerase chain reaction tests, and serologic tests for a period of 1 year after kidney transplantation and on an individual basis thereafter.ResultsThree patients (9%) developed PTLD including 2 early-onset (12 months) disease. In D+/R- and D-/R- patients, the frequencies of PTLD (8% vs. 12.5%, P = 0.7), EBV seroconversion (64% vs. 50%, P = 0.4), and EBV viremia (40% vs. 25%, P = 0.6) were not significantly different. Clinical, serologic, and virologic surveillance as well as reduction in immunosuppression after evidence of primary EBV infection resulted in a PTLD rate of 9%, despite a seroconversion rate of 60.6%. Rate of graft loss after reduction in immunosuppression was 10% (2 of 20), which was not significantly different from 13 patients without EBV seroconversion (no graft loss, P = 0.5). Rates of viremia, seroconversion, and PTLD in D+/R- and D-/R- patients appear to be similar.ConclusionsThe incidence of PTLD in renal transplants ranges from 0.5% to 2.9%. Our data show a significantly higher rate in EBV-seronegative renal allograft recipients, suggesting the need for close surveillance. Our data also suggest that donors for EBV-seronegative recipients may be accepted irrespective of positive or negative serostatus, with ongoing surveillance important in either circumstance.