1 Institute of Hematology, Davidoff Cancer Center, Beilinson Hospital, Rabin Medical Center, Petah-Tikva, Israel. 2 Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel. 3 Pulmonary Institute, Beilinson Hospital, Rabin Medical Center, Petah-Tikva, Israel. 4 Institute of Pathology, Rabin Medical Center, Petah-Tikva, Israel. 5 Address correspondence to: Eli Muchtar, M.D., Institute of Hematology, Davidoff Cancer Center, Beilinson Hospital, Rabin Medical Center, Petah-Tikva, Israel 49100.
Transplantation. 2013 Oct 15;96(7):657-63. doi: 10.1097/TP.0b013e31829b0718.
Posttransplantation lymphoproliferative disorder (PTLD) is a well-recognized complication after solid-organ transplantation. Historically, most cases of PTLD among lung transplant recipients occurred within the first year from transplantation and were associated with Epstein-Barr virus (EBV) infection. However, there are increasing reports on a late-onset form of PTLD.
We reviewed all charts of patients undergoing either lung or heart-lung transplantation in a tertiary transplantation center between the years 1997 and 2012 and compared clinical and pathologic parameters between early- and late-onset PTLD.
Ten patients with PTLD were identified. Median (range) time from transplantation to PTLD diagnosis was 41 (4-128) months. Three patients developed early PTLD. All were pretransplantation EBV seronegative and asymptomatic when diagnosed during surveillance chest imaging. In contrast, the seven patients with late-onset PTLD were all EBV seropositive before transplantation and were symptomatic at diagnosis. Although early-onset PTLD uniformly involved the transplanted lung, this was relatively rare in late-onset PTLD (3 of 3 vs. 1 of 7). All patients were initially treated with reduction of immunosuppression, with at least one additional treatment modality used, mainly chemoimmunotherapy. Eight patients attained complete remission. With a median follow-up of 17 months, 8 patients died, mainly from treatment-related causes rather than disease progression.
Our cohort of lung transplant recipients demonstrates a trend of late-onset PTLD with the majority of patients who died of treatment-related causes rather than disease progression. Therefore, substantial efforts should be focused on treatment-related mortality reduction.
移植后淋巴组织增生性疾病（PTLD）是实体器官移植后的一种公认的并发症。历史上，肺移植受者发生的大多数 PTLD 病例发生在移植后的第一年，与 EBV 感染有关。然而，越来越多的报告显示存在迟发性 PTLD。
我们回顾了 1997 年至 2012 年在一个三级移植中心接受肺或心肺移植的所有患者的病历，并比较了早发性和迟发性 PTLD 的临床和病理参数。
共发现 10 例 PTLD 患者。从移植到 PTLD 诊断的中位数（范围）时间为 41（4-128）个月。3 例发生早发性 PTLD。所有患者在移植前均为 EBV 血清阴性，在进行监测性胸部影像学检查时无症状。相比之下，7 例迟发性 PTLD 的患者在移植前均为 EBV 血清阳性，在诊断时出现症状。虽然早发性 PTLD 均累及移植肺，但这种情况在迟发性 PTLD 中相对少见（3 例中有 1 例）。所有患者最初均采用减少免疫抑制治疗，至少使用了另一种治疗方式，主要是化疗免疫治疗。8 例患者达到完全缓解。中位随访 17 个月后，8 例患者死亡，主要是由于治疗相关原因，而不是疾病进展。
我们的肺移植受者队列显示出迟发性 PTLD 的趋势，大多数患者因治疗相关原因而非疾病进展而死亡。因此，应集中精力降低与治疗相关的死亡率。
