Martín-Gómez M A, Peña M, Cabello M, Burgos D, Gutierrez C, Sola E, Acedo C, Bailén A, Gonzalez-Molina M
Servicio de Nefrología, Hospital Universitario Carlos Haya, Malaga, Spain.
Transplant Proc. 2006 Oct;38(8):2448-50. doi: 10.1016/j.transproceed.2006.08.050.
Posttransplant lymphoproliferative disease (PTLD) is a rare but clinically important disorder due to its increasing incidence and its impact on renal function and the life of the patient. Between 1979 and 2005, this center performed 1614 kidney transplants, and 23 patients had PTLD. We undertook a retrospective study, analyzing risk factors, presentation, and evolution of the disorder. The most common clinical presentation was fever and adenopathy. All cases except one received calcineurin inhibitors, and nine were treated with monoclonal or polyclonal antibodies. Serology for Epstein Barr virus (EBV) was negative in nine patients at the time of transplant, and in five it became positive on diagnosis of PTLD. The predominant disorder was non-Hodgkin's lymphoma (NHL), either polymorphous (n = 11) or monomorphous (n = 7). The base therapy consisted of reducing or suspending calcineurin inhibitors and the addition of sirolimus and antivirals. Three patients received rituximab, and five chemotherapy. The disease progressed in 36% of the polymorphous NHL, in 67% of the monomorphous, and in 100% of the Hodgkin's lymphoma, whereas 10 patients had remission. Renal function worsened on diagnosis in eight patients, and the graft was infiltrated in five (confirmed histologically). Five patients lost the graft and 12 died; six due to infection and five due to PTLD. Survival was worse in the patients aged over 55 years. We conclude that in most cases EBV is positive on diagnosis of the PTLD, an age older than 55 years affords a poor prognosis, and lymphocyte infiltration of the graft is common, as is worsening renal function.
移植后淋巴细胞增生性疾病（PTLD）是一种罕见但临床意义重大的疾病，因其发病率不断上升且对肾功能和患者生命产生影响。1979年至2005年间，该中心进行了1614例肾移植手术，其中23例患者发生了PTLD。我们进行了一项回顾性研究，分析该疾病的危险因素、临床表现及病情发展。最常见的临床表现是发热和淋巴结肿大。除1例患者外，所有病例均接受了钙调神经磷酸酶抑制剂治疗，9例患者接受了单克隆或多克隆抗体治疗。9例患者移植时爱泼斯坦-巴尔病毒（EBV）血清学检测为阴性，5例患者在诊断为PTLD时转为阳性。主要疾病为非霍奇金淋巴瘤（NHL），包括多形性（n = 11）或单形性（n = 7）。基础治疗包括减少或停用钙调神经磷酸酶抑制剂，并加用西罗莫司和抗病毒药物。3例患者接受了利妥昔单抗治疗，5例患者接受了化疗。多形性NHL患者中有36%病情进展，单形性NHL患者中有67%病情进展，霍奇金淋巴瘤患者中有100%病情进展，而10例患者病情缓解。8例患者诊断时肾功能恶化，5例患者的移植肾有浸润（经组织学证实）。5例患者移植肾丢失，12例患者死亡；6例死于感染，5例死于PTLD。55岁以上患者的生存率较差。我们得出结论，在大多数PTLD病例中，诊断时EBV呈阳性，年龄超过55岁预后较差，移植肾淋巴细胞浸润常见，肾功能恶化也常见。
