Paraskevas Steven, Coad James E, Gruessner Angelika, Kandaswamy Raja, Humar Abhinav, Sutherland David E R, Gruessner Rainer W G
Department of Surgery, University of Minnesota, Minneapolis, 55455, USA.
Transplantation. 2005 Sep 15;80(5):613-22. doi: 10.1097/01.tp.0000168366.07896.d7.
Posttransplant lymphoproliferative disorder (PTLD) is a rare, serious complication of transplantation. The characteristics and associations of this disease in pancreas recipients have not been extensively studied.
From January 1988 through December 2002, 787 pancreas and 569 kidney-pancreas transplants were performed at our institution. Eighteen pancreas recipients developed polymorphic PTLD or malignant lymphoma. Data on clinical course, organ involvement, molecular characteristics, and association with immunosuppression and recent cytomegalovirus (CMV) infection were compiled from the institutional transplant database. Patient survival was compared to recipients of liver and kidney transplants at the same center by using Kaplan-Meier analysis.
The 5-year cumulative incidence of PTLD in simultaneous pancreas-kidney, pancreas after kidney, and pancreas transplant alone recipients was 2.5%, 1.2%, and 1.0%, respectively (P = 0.23). A noticeably, but not significantly, higher cumulative incidence was seen in the more recent era since 1995 (2.1% vs. 0.9%, P = 0.15). PTLD in pancreas recipients carried a worse prognosis than in liver or kidney for recipients B-cell, early-onset, and Epstein Barr virus-positive lesions. PTLD was more aggressive in pancreas recipients, with a higher stage at presentation and a trend to more bone marrow involvement. There appeared to be a tendency toward association with recent CMV infection. Since 1995, PTLD recipients have had a lower exposure to antilymphocyte preparations (25 +/- 5 vs. 10 +/- 0.8)(P < 0.05).
PTLD in pancreas recipients remains a rare but aggressive disease, and carries a worse prognosis in comparison to other transplant recipients. These heavily immunosuppressed patients, who often face multiple transplants, may be at greater risk; CMV infection may play an antecedent role.
移植后淋巴细胞增生性疾病（PTLD）是一种罕见且严重的移植并发症。胰腺移植受者中该疾病的特征及相关因素尚未得到广泛研究。
1988年1月至2002年12月，我们机构共进行了787例胰腺移植和569例肾 - 胰腺联合移植。18例胰腺移植受者发生了多形性PTLD或恶性淋巴瘤。从机构移植数据库中收集了关于临床病程、器官受累情况、分子特征以及与免疫抑制和近期巨细胞病毒（CMV）感染相关性的数据。通过Kaplan - Meier分析，将患者生存率与同一中心的肝移植和肾移植受者进行比较。
同时进行肾 - 胰腺移植、肾移植后胰腺移植以及单纯胰腺移植受者中PTLD的5年累积发病率分别为2.5%、1.2%和l.0%（P = 0.23）。自1995年以来的最近时期，累积发病率明显但无显著升高（2.1%对0.9%，P = 0.15）。对于B细胞、早发型和爱泼斯坦 - 巴尔病毒阳性病变的受者，胰腺移植受者中的PTLD预后比肝移植或肾移植受者更差。PTLD在胰腺移植受者中更具侵袭性，表现为更高的分期以及有更多骨髓受累的趋势。似乎有与近期CMV感染相关的倾向。自1995年以来，PTLD受者接受抗淋巴细胞制剂的暴露量较低（25±5对10±0.8）（P < 0.05）。
胰腺移植受者中的PTLD仍然是一种罕见但侵袭性强的疾病，与其他移植受者相比预后更差。这些经常面临多次移植的免疫抑制严重的患者可能风险更大；CMV感染可能起先行作用。
