Morton Lindsay M, Landgren Ola, Chatterjee Nilanjan, Castenson David, Parsons Ruth, Hoover Robert N, Engels Eric A
Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Rockville, MD 20852, USA.
Blood. 2007 Dec 15;110(13):4599-605. doi: 10.1182/blood-2007-07-101956. Epub 2007 Sep 12.
Posttransplantation lymphoproliferative disorder (PTLD) is a serious complication of solid organ transplantation. Hepatitis C virus (HCV) infection has been linked to increased risk of lymphoma among immunocompetent individuals. We therefore investigated the association between HCV infection and PTLD in a retrospective cohort study of all individuals in the United States who received their first solid organ transplant from 1994 to 2005 (N = 210 763) using Scientific Registry of Transplant Recipients data. During follow-up, 1630 patients with PTLD were diagnosed. HCV prevalence at transplantation was 11.3%. HCV infection did not increase PTLD risk in the total cohort (Cox regression model, hazard ratio [HR] = 0.84; 95% confidence interval [CI] 0.68-1.05), even after adjustment for type of organ transplanted, indication for transplantation, degree of HLA mismatch, donor type, or use of immunosuppression medications. Additional analyses also revealed no association by PTLD subtype (defined by site, pathology, cell type, and tumor Epstein-Barr virus [EBV] status). HCV infection did increase PTLD risk among the 2.8% of patients (N = 5959) who were not reported to have received immunosuppression maintenance medications prior to hospital discharge (HR = 3.09; 95% CI, 1.14-8.42; P interaction = .007). Our findings suggest that HCV is not a major risk factor for PTLD, which is consistent with the model in which an intact immune system is necessary for development of HCV-related lymphoproliferation.
移植后淋巴细胞增生性疾病（PTLD）是实体器官移植的一种严重并发症。丙型肝炎病毒（HCV）感染与免疫功能正常个体患淋巴瘤的风险增加有关。因此，我们利用移植受者科学注册中心的数据，对1994年至2005年在美国接受首次实体器官移植的所有个体（N = 210763）进行了一项回顾性队列研究，以调查HCV感染与PTLD之间的关联。在随访期间，诊断出1630例PTLD患者。移植时HCV患病率为11.3%。在整个队列中，HCV感染并未增加PTLD风险（Cox回归模型，风险比[HR]=0.84；95%置信区间[CI]0.68 - 1.05），即使在调整了移植器官类型、移植指征、HLA错配程度、供体类型或免疫抑制药物使用情况之后也是如此。进一步分析还显示，按PTLD亚型（由部位、病理、细胞类型和肿瘤爱泼斯坦 - 巴尔病毒[EBV]状态定义）划分也无关联。在出院前未报告接受免疫抑制维持药物治疗的2.8%的患者（N = 5959）中，HCV感染确实增加了PTLD风险（HR = 3.09；95%CI，1.14 - 8.42；P交互作用 = 0.007）。我们的研究结果表明，HCV不是PTLD的主要危险因素，这与HCV相关淋巴细胞增生发展需要完整免疫系统的模型一致。
