Marqués E, Jiménez C, Manrique A, Vallejo G H, Clemares M, Ortega P, Moreno E
Servicio de Cirugá General, Ap. Digestivo y Trasplante de Organos Abdominales, Hospital Doce de Octubre, Madrid, Spain.
Transplant Proc. 2008 Nov;40(9):2988-9. doi: 10.1016/j.transproceed.2008.09.008.
Malignancies are a serious long-term complication among liver transplant recipients, with an overall incidence of 4.5%-15%. Posttransplantation lymphoproliferative disease (PTLD) is one of the leading causes of late death. Its development is related to complex interactions between immunosuppressive drugs and environmental agents. The aim of this study was to analyze risk factors for PTLD and survival after orthotopic liver transplantation (OLT) compared with solid tumors.
We undertook a retrospective review of the clinical histories of adult patients who underwent OLT between July 1986 and February 2001, and who had been followed until 2005. This study comprised 528 adult recipients who survived more than 2 months after OLT. We excluded pediatric, partial-organ, and multiorgan recipients.
No differences were observed concerning gender, viral etiology of hepatitis, calcineurin inhibitor regimen, or steroid maintenance period. Treated acute rejection episodes accounted for 53.3% of patients who developed PTLD compared with 47.3% in the control group (P = .787). Patients with solid tumors were older at the time of diagnosis than those with PTLD (57.5 +/- 8.13 years vs 48.8 +/- 13.9; P = .002). The overall mortality rate for PTLD was 55.5%, which did not differ significantly from solid tumors.
PTLD develops in younger patients after OLT. Various immunosuppressive regimens do not seem to influence the incidence of PTLD or other solid tumors.
恶性肿瘤是肝移植受者严重的长期并发症，总体发病率为4.5%-15%。移植后淋巴细胞增殖性疾病（PTLD）是晚期死亡的主要原因之一。其发生与免疫抑制药物和环境因素之间的复杂相互作用有关。本研究的目的是分析与实体瘤相比，原位肝移植（OLT）后PTLD的危险因素及生存率。
我们对1986年7月至2001年2月期间接受OLT并随访至2005年的成年患者的临床病史进行了回顾性研究。本研究包括528例OLT后存活超过2个月的成年受者。我们排除了儿科、部分器官和多器官受者。
在性别、肝炎病毒病因、钙调神经磷酸酶抑制剂方案或类固醇维持期方面未观察到差异。发生PTLD的患者中，接受治疗的急性排斥反应发作占53.3%，而对照组为47.3%（P = 0.787）。实体瘤患者诊断时的年龄比PTLD患者大（57.5±8.13岁对48.8±13.9岁；P = 0.002）。PTLD的总死亡率为55.5%，与实体瘤无显著差异。
OLT后PTLD在较年轻的患者中发生。各种免疫抑制方案似乎不会影响PTLD或其他实体瘤的发病率。
