Glez-Chamorro A, Jimenez C, Moreno-Glez E, Glez-Pinto I, Loinaz C, Gomez R, Garcia I, Alonso O, Palma F, Grande C
Department of General Surgery, Digestive System and Abdominal Organs Transplantation, Doce de Octubre Hospital, University of Madrid, Spain.
Hepatogastroenterology. 2000 Jan-Feb;47(31):211-9.
BACKGROUND/AIMS: The possibility of development of post-transplant lymphoproliferative disease by patients receiving immunosuppressive therapy is well known. However, elective treatment and outcome remain controversial. We reviewed the management and outcome of our patients with post-transplant lymphoproliferative disease.
Records of 457 patients who underwent orthotopic liver transplantation from 1986 to 1997 were analyzed. Patients who developed post-transplant lymphoproliferative disease were reviewed retrospectively. Incidence, clinical presentation, risk factors and outcomes were examined with special emphasis on ductopenic rejection and hilum involvement.
Eleven patients developed a post-transplant lymphoproliferative disease (2.4%). These were B-cell non-Hodgkins lymphoma, Epstein-Barr virus-associated in all cases. Five patients (45.5%) received monoclonal antibodies or antithymocyte globulin. Seven patients (63.6%) developed a lymphoproliferative disease before 9 months post-transplant and 4 recipients (36.4%) after 20 months. No late lymphomas regressed after withdrawal from immunosuppression. Six patients (54.5%) were treated with chemotherapy. Eight patients (72.7%) had a tumoral remission. Five patients (45.5%) developed chronic rejection after immunosuppressant discontinuation. Four of them died as a consequence of ductopenic rejection and retransplantation was required in another; 2 died due to graft hilum infiltration. Five patients (45.5%) are alive after a follow-up of 36.5 +/- 32 months (range: 4-77 months).
Patients with post-transplant lymphoproliferative disease require a close follow-up in order to promptly treat conditions that could lead to death. In our series, these were more closely associated with a failing transplanted organ than with the lymphoma itself.
背景/目的：接受免疫抑制治疗的患者发生移植后淋巴细胞增生性疾病的可能性是众所周知的。然而，选择性治疗及其结果仍存在争议。我们回顾了我们医院移植后淋巴细胞增生性疾病患者的治疗及预后情况。
分析了1986年至1997年间接受原位肝移植的457例患者的记录。对发生移植后淋巴细胞增生性疾病的患者进行回顾性分析。检查发病率、临床表现、危险因素及预后，特别关注胆管缺失性排斥反应和肝门受累情况。
11例患者发生了移植后淋巴细胞增生性疾病（2.4%）。这些均为B细胞非霍奇金淋巴瘤，所有病例均与EB病毒相关。5例患者（45.5%）接受了单克隆抗体或抗胸腺细胞球蛋白治疗。7例患者（63.6%）在移植后9个月内发生淋巴细胞增生性疾病，4例患者（36.4%）在20个月后发生。停用免疫抑制治疗后，晚期淋巴瘤均未消退。6例患者（54.5%）接受了化疗。8例患者（72.7%）肿瘤缓解。5例患者（45.5%）在停用免疫抑制剂后发生慢性排斥反应。其中4例因胆管缺失性排斥反应死亡，另1例需要再次移植；2例因移植肝门浸润死亡。5例患者（45.5%）在随访36.5±32个月（范围：4 - 77个月）后仍存活。
移植后淋巴细胞增生性疾病患者需要密切随访，以便及时治疗可能导致死亡的情况。在我们的系列研究中，这些情况与移植器官功能衰竭的关系比与淋巴瘤本身的关系更为密切。
