Younes B S, Ament M E, McDiarmid S V, Martin M G, Vargas J H
Department of Pediatrics, University of California, Los Angeles, USA.
J Pediatr Gastroenterol Nutr. 1999 Apr;28(4):380-5. doi: 10.1097/00005176-199904000-00007.
Posttransplant lymphoproliferative disease (PTLD) is a serious complication associated with the use of immunosuppression after transplantation. In a retrospective study the clinical features of PTLD located primarily in the gastrointestinal tract were analyzed.
Three hundred ninety-two consecutive pediatric patients who underwent orthotopic liver transplantation (OLT) during a 13-year period with a survival of more than 6 months were reviewed. Two immunosuppression protocols were used: cyclosporin A, or tacrolimus-based primary therapy. Twenty-nine randomly selected liver transplant recipients without PTLD were used for comparison of signs and symptoms of gastrointestinal PTLD.
Among the 30 patients identified with PTLD, 9 had gastrointestinal PTLD. The overall incidence density of PTLD was 1.8 per 100 patient-years (30/392). Nine patients (30%) had involvement of the gastrointestinal tract, whereas 7 (23%) had the gastrointestinal tract as the only involved site. When compared with a cohort of liver transplant recipients without PTLD, only gastrointestinal bleeding, weight loss, hypoalbuminemia, and protein-losing enteropathy were signs most likely associated with gastrointestinal PTLD. Hypoalbuminemia was the most sensitive sign of gastrointestinal PTLD. The lower tract (ileum and colon) was the most common site of involvement.
gastrointestinal involvement is common and occurs in 30% of all patients with PTLD. It may be the only affected organ in a subgroup of patients. Hypoalbuminemia, gastrointestinal bleeding, and weight loss are features that are characteristic of gastrointestinal PTLD. Patients with aggressive gastrointestinal signs and symptoms should undergo upper and lower gastrointestinal tract endoscopy with biopsy, to establish the diagnosis.
移植后淋巴组织增生性疾病（PTLD）是移植后使用免疫抑制剂相关的一种严重并发症。在一项回顾性研究中，分析了主要位于胃肠道的PTLD的临床特征。
回顾了在13年期间接受原位肝移植（OLT）且存活超过6个月的392例连续儿科患者。使用了两种免疫抑制方案：以环孢素A或他克莫司为基础的初始治疗。随机选择29例无PTLD的肝移植受者，用于比较胃肠道PTLD的体征和症状。
在确诊为PTLD的30例患者中，9例有胃肠道PTLD。PTLD的总体发病密度为每100患者年1.8例（30/392）。9例患者（30%）有胃肠道受累，而7例（23%）以胃肠道为唯一受累部位。与无PTLD的肝移植受者队列相比，只有胃肠道出血、体重减轻、低白蛋白血症和蛋白丢失性肠病是最可能与胃肠道PTLD相关的体征。低白蛋白血症是胃肠道PTLD最敏感的体征。下消化道（回肠和结肠）是最常见的受累部位。
胃肠道受累很常见，在所有PTLD患者中占30%。它可能是一部分患者中唯一受影响的器官。低白蛋白血症、胃肠道出血和体重减轻是胃肠道PTLD的特征性表现。有侵袭性胃肠道体征和症状的患者应接受上、下消化道内镜检查及活检以明确诊断。
