Malouf Monique A, Chhajed Prashant N, Hopkins Peter, Plit Marshall, Turner Jenny, Glanville Allan R
Lung Transplant Unit, St. Vincent's Hospital, Darlinghurst, Sydney, Australia.
J Heart Lung Transplant. 2002 May;21(5):547-54. doi: 10.1016/s1053-2498(01)00407-7.
Post-transplant lymphoproliferative disease (PTLD) is a serious, often fatal complication after solid organ transplantation. Primary Epstein-Barr virus (EBV) infection is the major risk factor for PTLD after lung transplantation, with 30% to 50% of EBV-naive patients who seroconvert and are diagnosed with PTLD.
In this study, we analyzed the incidence of PTLD in lung and heart-lung transplant recipients before 1996 (historic group) and then compared the impact of long-term anti-viral prophylaxis on the development of PTLD in EBV-seronegative recipients from January 1996 to December 2000 (post-1996 group). Routine induction therapy was not given after 1995. Patients not surviving 30 days, 25 of 341 (7.3%), were excluded.
Historic group: PTLD developed in 7 of 167 (4.2%) patients, at a mean of 394 +/- 278 (95-885) days. The mortality was 87.5% at a mean follow-up of 186 +/- 207 (17-520) days after diagnosis. Post-1996 group: Eighteen of 149 (12.3%) patients were EBV seronegative at the time of transplantation, and of these 15 (83%) began receiving continuous anti-viral prophylaxis: acyclovir or valacyclovir or ganciclovir from January 1996. None of the EBV-seronegative recipients receiving continuous anti-viral prophylaxis were diagnosed with PTLD; however, 1 of 3 (33%) of the EBV-seronegative recipients who did not receive anti-viral prophylaxis were diagnosed with PTLD. In the EBV-seronegative recipients, no deaths had been caused by PTLD at a mean follow-up of 806 +/- 534 (39-1,084) days. In the post-1996 group, PTLD developed in 1 of 131 (0.76%) EBV-seropositive recipients.
Continuous, specific anti-viral prophylaxis in high-risk EBV-seronegative recipients significantly reduces the incidence of PTLD after lung transplantation in the absence of induction therapy.
移植后淋巴细胞增生性疾病（PTLD）是实体器官移植后一种严重且常致命的并发症。原发性爱泼斯坦 - 巴尔病毒（EBV）感染是肺移植后PTLD的主要危险因素，30%至50%的EBV血清学阴性患者在血清转化并被诊断为PTLD。
在本研究中，我们分析了1996年前肺移植和心肺移植受者中PTLD的发生率（历史组），然后比较了1996年1月至2000年12月期间长期抗病毒预防对EBV血清学阴性受者发生PTLD的影响（1996年后组）。1995年后未给予常规诱导治疗。未存活30天的患者，341例中有25例（7.3%）被排除。
历史组：167例患者中有7例（4.2%）发生PTLD，平均发生时间为394±278（95 - 885）天。诊断后平均随访186±207（17 - 520）天，死亡率为87.5%。1996年后组：149例患者中有18例（12.3%）在移植时为EBV血清学阴性，其中15例（83%）从1996年1月开始接受持续抗病毒预防：阿昔洛韦或伐昔洛韦或更昔洛韦。接受持续抗病毒预防的EBV血清学阴性受者均未被诊断为PTLD；然而，未接受抗病毒预防的EBV血清学阴性受者中有1例（33%）被诊断为PTLD。在EBV血清学阴性受者中，平均随访806±534（39 - 1084）天，无PTLD导致的死亡。在1996年后组中，131例EBV血清学阳性受者中有1例（0.76%）发生PTLD。
在无诱导治疗的情况下，对高危EBV血清学阴性受者进行持续、特异性的抗病毒预防可显著降低肺移植后PTLD的发生率。
