Kremers W K, Devarbhavi H C, Wiesner R H, Krom R A F, Macon W R, Habermann T M
The William J. von Liebig Transplant Center, Mayo Clinic and Mayo Clinic College of Medicine, Rochester, MN 55905, USA.
Am J Transplant. 2006 May;6(5 Pt 1):1017-24. doi: 10.1111/j.1600-6143.2006.01294.x.
This study investigates retrospectively the incidence, risk factors and mortality of post-transplant lymphoproliferative disorders (PTLD) in adult orthotopic liver transplant (OLT) recipients. Among 1206 OLT recipients at a single institution, 37 developed a PTLD. The incidence of PTLD was highest during the first 18 months and relatively constant thereafter with cumulative incidence of 1.1% at 18 months and 4.7% at 15 years. The risk of PTLD was approximately 10% to 15% of the risk of death without PTLD. During the first 4 years following OLT, PTLD were predominantly related to EBV, while afterward most PTLD were EBV negative. Significant risk factors for PTLD in OLT recipients were transplantation for acute fulminant hepatitis during the first 18 months following OLT (HR=2.6, p=0.007), and rejection therapy with high-dose steroids (HR=4.5, p=0.049) and OKT3 (HR=3.9, p=0.016) during the previous year. Therapy with high-dose steroids or OKT3 (HR=3.6, p=0.0071) were also significant risk factors for PTLD-associated mortality. OLT recipients remain at risk for PTLD years after transplantation. The strong association of PTLD with rejection therapy and the worse post-PTLD prognosis among recipients of rejection therapy indicate the need to balance the risk of immunosuppression against the risk of PTLD following rejection treatment.
本研究回顾性调查了成人原位肝移植（OLT）受者中移植后淋巴细胞增生性疾病（PTLD）的发病率、危险因素及死亡率。在一家机构的1206例OLT受者中，37例发生了PTLD。PTLD的发病率在最初18个月内最高，此后相对稳定，18个月时累积发病率为1.1%，15年时为4.7%。PTLD的风险约为无PTLD时死亡风险的10%至15%。在OLT后的前4年，PTLD主要与EB病毒相关，而此后大多数PTLD为EB病毒阴性。OLT受者发生PTLD的显著危险因素包括OLT后最初18个月内因急性暴发性肝炎进行移植（HR=2.6，p=0.007），以及前一年接受大剂量类固醇（HR=4.5，p=0.049）和OKT3（HR=3.9，p=0.016）的抗排斥治疗。接受大剂量类固醇或OKT3治疗（HR=3.6，p=0.0071）也是PTLD相关死亡的显著危险因素。OLT受者在移植多年后仍有发生PTLD的风险。PTLD与抗排斥治疗的密切关联以及抗排斥治疗受者中PTLD后预后较差表明，需要在免疫抑制风险与抗排斥治疗后PTLD风险之间进行权衡。
