Epstein-Barr Virus and Posttransplant Lymphoproliferative Disorders
Epstein-Barr Virus and Posttransplant Lymphoproliferative Disorders
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EB 病毒和移植后淋巴细胞增殖性疾病
DOI：
10.1007/978-3-030-01751-4_27-1
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发表时间：
2020
期刊：
影响因子：
--
通讯作者：
Green Michael
中科院分区：
文献类型：
--
作者：
Yamada Masaki;Nowalk Andrew;Green Michael
EB病毒（Epstein-Barr virus，EBV）是导致实体器官移植（solid organ，SOT）和造血干细胞移植（hematopoietic stem cell transplantation，HSCT）患儿发病和死亡的重要原因。EBV病毒与免疫活性患者和免疫功能低下患者的一系列临床症状和综合征相关，这是基于病毒转化和永生化B淋巴细胞的能力，导致病毒驱动的受感染B细胞增殖。在免疫活性宿主中，这种增殖主要由EBV特异性细胞毒性T淋巴细胞（CTL）控制。然而，在免疫抑制的SOT和HSCT受体中，CTL功能的受损可导致不受抑制的增殖和EBV相关的移植后淋巴组织增生性疾病（PTLD）的发展。在SOT受者中，EBV相关的主要风险因素是在移植前对病毒呈血清阴性，并在移植后发生原发性感染，而在一般情况下，在移植前EBV血清阳性的SOT受者患病风险很小。对于HSCT，主要风险因素与EBV状态和供体的潜在T细胞耗竭有关，以尽量减少移植物抗宿主病（GVHD）的风险。在SOT和HSCT中，与EBV感染相关的不良结局导致了优化治疗和制定预防策略以减轻这种病原体的影响的努力。本章将回顾流行病学，诊断，治疗和预防EBV疾病，包括PTLD在SOT和HSCT收件人。
Epstein-Barr virus (EBV) is an important potential cause of morbidity and mortality in children and adults undergoing solid organ (SOT) and hematopoietic stem cell transplantation (HSCT). The EBV virus is associated with a range of clinical symptoms and syndromes in both immunocompetent and immunocompromised patients based upon the virus’ ability to transform and immortalize B lymphocytes leading to viral-driven proliferation of infected B cells. In the immunocompetent host, this proliferation is primarily controlled by EBV-specific cytotoxic T lymphocytes (CTL). However, in the immunosuppressed SOT and HSCT recipient, impairment of the function of CTL can lead to unchecked proliferation and the development of EBV-associated posttransplant lymphoproliferative disorder (PTLD). In SOT recipients, the major risk factor for EBV-associated is being seronegative to the virus prior to and developing primary infection after the transplant, while in general SOT recipients who are EBV seropositive prior to transplant are at little risk for disease. For HSCT, the major risk factor relates to the EBV status and the potential T-cell depletion of the donor in an effort to minimize the risk of graft-versus-host disease (GVHD). In both SOT and HSCT, adverse outcomes relating to EBV infection led to efforts to optimize treatment and to develop preventive strategies to mitigate the impact of this pathogen. This chapter will review epidemiology, diagnosis, treatment, and prevention of EBV disease including PTLD in SOT and HSCT recipients.