肝移植患者的移植后淋巴细胞增生性疾病：4例报告
Posttransplant lymphoproliferative disorders in liver transplanted patients: a report of four cases.
作者信息
Lorenzini S, Andreone P, Gramenzi A, Morelli C, Zinzani P L, Grazi G L, Pileri S, Baccarani M, Tura S, Bernardi M
机构信息
Department of Internal Medicine, Cardioangiology and Hepatology, University of Bologna, and Department of Gastroenterology and Internal Medicine, Orsola-Malpighi Hospital, Bologna, Italy.
出版信息
Transplant Proc. 2006 Jun;38(5):1477-80. doi: 10.1016/j.transproceed.2006.02.110.
BACKGROUND
Posttransplant lymphoproliferative disorders (PTLDs) are an uncommon but important cause of morbidity and mortality in solid organ transplant recipients. They are often the result of Epstein-Barr virus (EBV)-induced proliferation of B-lymphocytes in the setting of immunosuppression.
PATIENTS AND METHODS
We retrospectively analyzed four cases of PTLD after liver transplantation. In all patients immunosuppression was reduced and anti-CD20 monoclonal antibody (rituximab) was administered. In two of four patients, EBV viral load was positive in the peripheral blood, and gancyclovir was therefore also prescribed. Chemotherapy (CHOP) was used as a rescue in the event of treatment failure.
RESULTS
Even if no severe adverse events were observed during the treatment period, our treatment approach to PTLD was not effective, and only one patient out of four is still alive.
CONCLUSIONS
Well-designed clinical trials are necessary to evaluate the role of this combined approach in the treatment of PTLD in liver transplant recipients.
背景
移植后淋巴细胞增生性疾病（PTLD）在实体器官移植受者中虽不常见，但却是发病和死亡的重要原因。它们通常是在免疫抑制情况下，爱泼斯坦-巴尔病毒（EBV）诱导B淋巴细胞增殖的结果。
患者与方法
我们回顾性分析了4例肝移植后发生PTLD的病例。所有患者均减少了免疫抑制，并给予抗CD20单克隆抗体（利妥昔单抗）。4例患者中有2例外周血EBV病毒载量呈阳性，因此还给予了更昔洛韦。若治疗失败，则采用化疗（CHOP方案）进行挽救。
结果
尽管在治疗期间未观察到严重不良事件，但我们对PTLD的治疗方法无效，4例患者中仅1例仍存活。
结论
有必要开展设计良好的临床试验，以评估这种联合治疗方法在肝移植受者PTLD治疗中的作用。
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