Post-transplant lymphoproliferative disease in heart and lung transplantation: Defining risk and prognostic factors
Post-transplant lymphoproliferative disease in heart and lung transplantation: Defining risk and prognostic factors
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DOI：
10.1016/j.healun.2015.05.021
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发表时间：
2015-11-01
影响因子：
8.9
通讯作者：
Moore, John J.
中科院分区：
文献类型：
--
作者：
Kumarasinghe, Gayathri;Lavee, Orly;Moore, John J.
背景：心脏和肺移植受者是移植后淋巴组织增生性疾病（PTLD）发病率最高的人群之一。尽管如此，关于这一群体的具体数据仍然很少。我们整理了心脏、肺和心肺移植受者PTLD的数据，以确定该组患者特有的疾病特征和预后因素。方法：从1984年至2013年，从一家机构确定了70例PTLD（41例心脏，22例肺，6例心肺和1例心肾移植）。分析人口统计学、免疫抑制、治疗、反应、并发症和生存数据。结果：PTLD的发生率分别为：心肺移植7.59%，心脏移植5.37%，肺移植3.1%。结外病变（82%）和弥漫性大B细胞淋巴瘤（72%）是最常见的表现。骨髓受累（13%）和中枢神经系统疾病（3%）不常见。与肺和心肺移植者相比，心脏移植者发生FTLD的时间较晚（移植后> 1年），移植物受累较少。预后不良的标志物是骨髓受累（FIR 6.75，p < 0.001）和血清白蛋白
BACKGROUND: Heart and lung transplant recipients have among of the highest incidence rates of post-transplant lymphoproliferative disease (PTLD). Despite this, there is a paucity of data specific to this group. We collated data on heart, lung and heart lung transplant recipients with PTLD to identify disease features and prognostic factors unique to this group of patients.METHODS: Seventy cases of PTLD were identified from a single institution (41 heart, 22 lung, 6 heart lung and 1 heart kidney transplant) from 1984 to 2013. Demographics, immunosuppression, treatment, response, complications and survival data were analyzed. Uni- and multivariate Cox regression analyses were performed to identify prognostic factors.RESULTS: The incidence of PTLD was 7.59% in heart lung, 5.37% in heart and 3.1% in lung transplant recipients. Extranodal disease (82%) with diffuse large B-cell lymphoma (72%) was the most common presentation. Bone marrow involvement (13%) and central nervous system disease (3%) were uncommon. Heart transplant recipients had later onset of FTLD (> 1 year post-transplant), with less allograft involvement, compared with lung and heart lung recipients. Poor prognostic markers were bone marrow involvement (FIR 6.75, p < 0.001) and serum albumin