Laboratori Sperimentali di Ricerca, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy.
Virol J. 2011 Sep 5;8:421. doi: 10.1186/1743-422X-8-421.
Post-transplant lymphoproliferative disorders (PTLD) are serious complications in lung transplant recipients. No consensus on EBV DNAemia levels predictive of PTLD has been reached. In addition, in many instances EBV DNAemia is determined in patients with suggestive symptoms only.
The characteristics of five patients with PTLD as well as the prevalence of EBV DNAmia in a cohort of 137 consecutive patients receiving lung transplantation are described.
Twenty-six out of 137 patients (18.9%) were excluded from the analysis because lost at follow-up or dead from PTLD-independent reasons within three months of transplantation. EBV DNA in peripheral blood mononuclear cells (PBMC) was determined in 83/111 patients (74.8%) because of potential PTLD-related symptoms, while 28 patients (25.2%) showed no symptoms and were not examined. EBV DNAemia was positive in 53/83 patients (63.8%), and negative in 30/83 patients (36.2%). PTLD was diagnosed in five (4.5%) patients at a median time of 270 (range 120-870) days following transplantation. All five PTLD (three large B-cell lymphomas, one Hodgkin lymphoma and one possible pre-neoplastic lesion) were potentially associated with EBV infection. However, only 3/5 patients with PTLD had detectable EBV DNAemia: < 1,000 copies EBV DNA/1 × 10⁵ PBMC in one patient and > 1,000 copies EBV DNA/1 × 10⁵ PBMC in two patients.
A systematic multidisciplinary (clinical, radiologic, virologic and histologic) approach is mandatory for the diagnosis and management of PTLD in lung transplant recipients, while monitoring of symptomatic patients only may provide an incomplete or late picture of the clinical problem. In addition, staining for EBV antigens and quantification of EBV DNA in biopsy specimens should always be performed to understand the role of EBV infection in the pathogenesis of PTLD.
移植后淋巴组织增生性疾病（PTLD）是肺移植受者的严重并发症。目前尚未就预测 PTLD 的 EBV DNA 血症水平达成共识。此外，在许多情况下，仅在有提示症状的患者中确定 EBV DNA 血症。
描述了 5 例 PTLD 患者的特征以及在接受肺移植的 137 例连续患者队列中 EBV DNA 血症的患病率。
由于在移植后三个月内随访丢失或因与 PTLD 无关的原因死亡，137 例患者中有 26 例（18.9%）被排除在分析之外。由于潜在的与 PTLD 相关的症状，对 83/111 例患者（74.8%）测定外周血单个核细胞（PBMC）中的 EBV DNA，而 28 例患者（25.2%）无症状且未检查。83 例患者中有 53 例（63.8%）EBV DNA 血症阳性，30 例（36.2%）EBV DNA 血症阴性。在移植后中位数时间为 270 天（范围 120-870 天）的 5 例患者中诊断为 PTLD（4.5%）。所有 5 例 PTLD（3 例大 B 细胞淋巴瘤、1 例霍奇金淋巴瘤和 1 例可能的前肿瘤病变）均与 EBV 感染有关。然而，仅有 3/5 例 PTLD 患者可检测到 EBV DNA 血症：1 例患者 EBV DNA/1 × 105 PBMC < 1000 拷贝，2 例患者 EBV DNA/1 × 105 PBMC > 1000 拷贝。
对肺移植受者的 PTLD 进行诊断和管理必须采用系统的多学科（临床、放射学、病毒学和组织学）方法，而仅监测有症状的患者可能提供临床问题的不完整或延迟图像。此外，应始终对活检标本进行 EBV 抗原染色和 EBV DNA 定量，以了解 EBV 感染在 PTLD 发病机制中的作用。
