Weiner Chana, Weintraub Lauren, Wistinghausen Birte, Tomaino Juli, Arnon Ronen, Kerkar Nanda, Miloh Tamir
Department of Pediatrics, Mount Sinai Medical Center, New York, NY, USA.
Pediatr Transplant. 2012 Aug;16(5):458-64. doi: 10.1111/j.1399-3046.2012.01713.x. Epub 2012 May 4.
Treatment of primary EV and PTLD in pediatric LT recipients (pLT) involves IS reduction/cessation. Retrospective review of pLT at our institution from 2001-2009 was conducted to characterize risk factors for GR after EV/ PTLD. Of 184 pLT, EV occurred in 61 (33%) at mean 16.5 m (0-82) and PTLD in 18 (9.8%) at mean 17.7 m (3-78) post-LT. Median age at pLT was 11 m (1-245 m) and follow-up six yr. For EV, 86% underwent IS reduction and 51% received antivirals. GR occurred in 12 (27.9%) with EV and 15 (83.3%) after PTLD diagnosis (relative risk of GR for PTLD 2.98). GR treated with methylprednisolone bolus in half and/or oral IS in half. Following GR therapy, four had PTLD relapses, no graft loss and one EV patient required re-transplantation. GR history before EV was a risk factor for GR after EV (p = 0.024). GR at any point after pLT was a risk factor for PTLD (p = 0.001). Children with EV and GR prior to EV should be monitored closely for GR after IS reduction and GR is a significant risk factor for PTLD. Most children with PTLD eventually developed GR.
小儿肝移植（pLT）受者原发性EB病毒（EV）感染和移植后淋巴增殖性疾病（PTLD）的治疗包括减少或停用免疫抑制剂（IS）。我们对本机构2001年至2009年的pLT进行了回顾性研究，以确定EV/PTLD后发生移植物排斥（GR）的危险因素。184例pLT中，61例（33%）发生EV，平均时间为肝移植后16.5个月（0 - 82个月）；18例（9.8%）发生PTLD，平均时间为肝移植后17.7个月（3 - 78个月）。pLT时的中位年龄为11个月（1 - 245个月），随访6年。对于EV，86%的患者减少了IS用量，51%的患者接受了抗病毒治疗。12例（27.9%）EV患者发生GR，15例（83.3%）在诊断PTLD后发生GR（PTLD发生GR的相对风险为2.98）。一半的GR患者接受了甲泼尼龙冲击治疗，另一半接受了口服IS治疗。GR治疗后，4例发生PTLD复发，无移植物丢失，1例EV患者需要再次移植。EV发生前有GR病史是EV后发生GR的危险因素（p = 0.024）。pLT后任何时间发生GR是PTLD的危险因素（p = 0.001）。EV患者且在EV前发生GR的儿童在减少IS用量后应密切监测GR情况，GR是PTLD的重要危险因素。大多数PTLD患儿最终发生了GR。
