Mucha Krzysztof, Foroncewicz Bartosz, Niemczyk Kazimierz, Ziarkiewicz-Wróblewska Bogna, Stanisławek-Sut Olimpia, Zieniewicz Krzysztof, Krawczyk Marek, Paczek Leszek
Transplantation Institute, Department of Immunology, Transplantology and Internal Medicine, Warsaw Medical University, Warsaw, Poland.
Liver Transpl. 2007 Jun;13(6):918-23. doi: 10.1002/lt.21177.
Posttransplantation lymphoproliferative disease (PTLD) is a well-known complication of solid organ and bone marrow transplantation. It is agreed that the main causes of PTLD are chronic infection with Epstein-Barr virus (EBV); the intensity, rather then the type, of immunosuppression used; and underlying recipient disease. Hepatitis C virus (HCV) and cytomegalovirus, as cofactors of EBV infection, have been suggested to increase the risk of PTLD. Use of calcineurin inhibitors, anti-CD3 monoclonal antibody (OKT3), and antithymocyte globulin may increase the risk of PTLD. On the other hand, mycophenolate mofetil, sirolimus, and the anti-interleukin-2 receptor monoclonal antibodies Daclizumab and basiliximab have not been demonstrated to increase the risk of PTLD. The incidence of PTLD after liver transplantation (LT) is estimated to be 1.5-3%, but a tonsillar location is extremely rare in adults. Thus, little is known about the best diagnostic tools for and treatment by LT recipients with tonsillar PTLD. Here, we report 2 cases of adult LT recipients with tonsillar PTLD. Tonsillectomy was used as a diagnostic tool and treatment option and resulted in complete remission for >2 years. Considering the high mortality and diagnostic difficulties of PTLD, together with the relatively low risks of tonsillectomy, we recommend tonsillectomy for treating tonsil enlargement of unknown cause and suspected PTLD in LT recipients. A larger series of patients and prospective studies comparing different treatment options will be needed to substantiate our recommendation.
移植后淋巴细胞增生性疾病（PTLD）是实体器官和骨髓移植中一种众所周知的并发症。人们一致认为，PTLD的主要病因是爱泼斯坦-巴尔病毒（EBV）的慢性感染、免疫抑制的强度而非类型，以及受体的基础疾病。丙型肝炎病毒（HCV）和巨细胞病毒作为EBV感染的辅助因子，被认为会增加PTLD的风险。使用钙调神经磷酸酶抑制剂、抗CD3单克隆抗体（OKT3）和抗胸腺细胞球蛋白可能会增加PTLD的风险。另一方面，霉酚酸酯、西罗莫司以及抗白细胞介素-2受体单克隆抗体达利珠单抗和巴利昔单抗尚未被证明会增加PTLD的风险。肝移植（LT）后PTLD的发生率估计为1.5%-3%，但在成人中扁桃体部位极为罕见。因此，对于LT受体发生扁桃体PTLD的最佳诊断工具和治疗方法知之甚少。在此，我们报告2例成人LT受体发生扁桃体PTLD的病例。扁桃体切除术被用作诊断工具和治疗选择，并导致完全缓解超过2年。考虑到PTLD的高死亡率和诊断困难，以及扁桃体切除术相对较低的风险，我们建议对LT受体中原因不明的扁桃体肿大和疑似PTLD进行扁桃体切除术。需要更多的患者系列研究和比较不同治疗选择的前瞻性研究来证实我们的建议。
