Idiopathic pulmonary fibrosis lung transplant recipients are at increased risk for EBV-associated posttransplant lymphoproliferative disorder and worse survival.
Idiopathic pulmonary fibrosis lung transplant recipients are at increased risk for EBV-associated posttransplant lymphoproliferative disorder and worse survival.
复制标题
DOI：
10.1111/ajt.15756
复制
发表时间：
2020-05
期刊：
影响因子：
--
通讯作者：
McDyer JF
中科院分区：
文献类型：
--
作者：
Iasella CJ;Winters SA;Kois A;Cho J;Hannan SJ;Koshy R;Moore CA;Ensor CR;Lendermon EA;Morrell MR;Pilewski JM;Sanchez PG;Kass DJ;Alder JK;Nouraie SM;McDyer JF
eb病毒（EBV）相关的移植后淋巴细胞增生性疾病（EBV- ptld）是肺移植受者（lts）的一种严重并发症，与显著的死亡率相关。我们进行了一项单中心回顾性研究，以评估ltr患者在7年内发生PTLD的风险。在611例可评估的ltr中，我们确定了28例PTLD，发生率为4.6%。Kaplan-Meier分析显示特发性肺纤维化(IPF)- lts的PTLD自由度降低（P < 0.02）。使用多变量Cox比例风险模型，我们发现IPF（风险比[HR] 3.51, 95%可信区间[CI] 1.33-8.21, P = 0.01）和阿仑单抗诱导治疗（HR 2.73, 95% CI 1.10-6.74, P = 0.03）是PTLD的危险因素，而EBV不匹配（HR: 34.43, 95% CI 15.57-76.09, P < 0.0001）是高危因素。早期PTLD（第一年）与阿仑妥珠单抗使用相关（P = 0.04），而在控制年龄和性别后，IPF是晚期PTLD（第一年）的预测因子（P = 0.002）。Kaplan-Meier分析显示，与其他患者相比，IPF ltr患者的PTLD死亡时间更短（P = 0.04）。在EBV不匹配的患者中使用阿仑单抗被发现特别增加了PTLD的风险。总之，我们的研究结果确定了IPF ltr是PTLD的易感人群。需要进一步的研究来了解IPF ltr中PTLD的驱动机制，并制定降低风险的策略。
Epstein-Barr virus (EBV)–associated posttransplant lymphoproliferative disorder (EBV-PTLD) is a serious complication in lung transplant recipients (LTRs) associated with significant mortality. We performed a single-center retrospective study to evaluate the risks for PTLD in LTRs over a 7-year period. Of 611 evaluable LTRs, we identified 28 cases of PTLD, with an incidence of 4.6%. Kaplan-Meier analysis showed a decreased freedom from PTLD in idiopathic pulmonary fibrosis (IPF)-LTRs (P < .02). Using a multivariable Cox proportional hazards model, we found IPF (hazard ratio [HR] 3.51, 95% confidence interval [CI] 1.33–8.21, P = .01) and alemtuzumab induction therapy (HR 2.73, 95% CI 1.10–6.74, P = .03) as risk factors for PTLD, compared to EBV mismatch (HR: 34.43, 95% CI 15.57–76.09, P < .0001). Early PTLD (first year) was associated with alemtuzumab use (P = .04), whereas IPF was a predictor for late PTLD (after first year) (P = .002), after controlling for age and sex. Kaplan-Meier analysis revealed a shorter time to death from PTLD in IPF LTRs compared to other patients (P = .04). The use of alemtuzumab in EBV mismatch was found to particularly increase PTLD risk. Together, our findings identify IPF LTRs as a susceptible population for PTLD. Further studies are required to understand the mechanisms driving PTLD in IPF LTRs and develop strategies to mitigate risk.
登录
查看更多内容
影响因子：
4.6
作者：
Courtwright, Andrew M.;Burkett, Patrick;Mallidi, Hari R.
通讯作者：
Mallidi, Hari R.
DOI：
10.1164/rccm.200804-550oc
发表时间：
2008-10-01
影响因子：
24.7
作者：
Cronkhite, Jennifer T.;Xing, Chao;Garcia, Christine Kim
通讯作者：
Garcia, Christine Kim
影响因子：
2.9
作者：
Al-Mansour Z;Nelson BP;Evens AM
通讯作者：
Evens AM
影响因子：
8.9
作者：
Kremer, Brandon E.;Reshef, Ran;Tsai, Donald E.
通讯作者：
Tsai, Donald E.
影响因子：
3.1
作者：
Martinez-Calle, Nicolas;Alfonso, Ana;Panizo, Carlos
通讯作者：
Panizo, Carlos