肺移植后移植后淋巴组织增生性疾病：35 例回顾。
Post-transplant lymphoproliferative disorder after lung transplantation: a review of 35 cases.
机构信息
Abramson Cancer Center, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA, USA.
出版信息
J Heart Lung Transplant. 2012 Mar;31(3):296-304. doi: 10.1016/j.healun.2011.10.013. Epub 2011 Nov 23.
BACKGROUND
Post-transplant lymphoproliferative disorder (PTLD) is a complication of organ transplantation. The risk of developing PTLD varies depending on a number of factors, including the organ transplanted and the degree of immunosuppression used.
METHODS
We report a retrospective analysis of 35 patients with PTLD treated at our center after lung transplantation. Of 705 patients who received allografts, 34 (4.8%) developed PTLD. One patient underwent transplantation elsewhere and was treated at our center.
RESULTS
PTLD involved the allograft in 49% of our patients and the gastrointestinal (GI) tract lumen in 23%. Histologically, 39% of tumors were monomorphic and 48% polymorphic. The time to presentation defined the location and histology of disease. Of 17 patients diagnosed within 11 months of transplantation, PTLD involved the allograft in 12 (71%) and the GI tract in 1 (p = 0.01). This "early" PTLD was 85% polymorphic (p = 0.006). Conversely, of the 18 patients diagnosed more than 11 months after transplant, the lung was involved in 5 (28%) and the GI tract in 7 (39%; p = 0.01). "Late" PTLD was 71% monomorphic (p = 0.006). Median overall survival after diagnosis was 18.57 months. Overall survival did not differ between all lung transplant recipients and those who developed PTLD.
CONCLUSIONS
PTLD is an uncommon complication after lung transplantation, and its incidence declined remarkably in the era of modern immunosuppression. We report several factors that are important for predisposition toward, progression of, and treatment of PTLD after lung transplantation.
背景
移植后淋巴组织增生性疾病（PTLD）是器官移植的并发症。发生 PTLD 的风险取决于多种因素，包括移植的器官和使用的免疫抑制程度。
方法
我们报告了在我们中心接受肺移植后治疗的 35 例 PTLD 患者的回顾性分析。在接受同种异体移植物的 705 例患者中，有 34 例（4.8%）发生了 PTLD。有 1 例患者在其他地方接受了移植，并在我们中心接受了治疗。
结果
PTLD 累及移植物的患者占 49%，累及胃肠道（GI）腔的患者占 23%。组织学上，39%的肿瘤为单形性，48%为多形性。发病时间决定了疾病的部位和组织学特征。在 17 例诊断为移植后 11 个月内的患者中，PTLD 累及移植物的患者有 12 例（71%），累及 GI 道的患者有 1 例（p = 0.01）。这种“早期”PTLD 有 85%为多形性（p = 0.006）。相反，在 18 例诊断为移植后超过 11 个月的患者中，累及肺的患者有 5 例（28%），累及 GI 道的患者有 7 例（39%；p = 0.01）。“晚期”PTLD 有 71%为单形性（p = 0.006）。诊断后的中位总生存期为 18.57 个月。肺移植受者和发生 PTLD 的患者的总生存期无差异。
结论
PTLD 是肺移植后的一种罕见并发症，在现代免疫抑制时代，其发病率显著下降。我们报告了一些对肺移植后发生 PTLD 的易感性、进展和治疗有重要影响的因素。
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