Akar Özkan Eylem, Özdemir B Handan, Deniz E Ebru, Tunca M Zeyneb, Haberal Mehmet
Department of Pathology, Baskent University Faculty of Medicine, Ankara, Turkey.
Exp Clin Transplant. 2014 Mar;12 Suppl 1:142-8.
We evaluated posttransplant lymphoproliferative disorder after solid-organ transplant.
All 2224 solid-organ transplant recipients who underwent transplant between 1985 and 2013 were included. Clinicopathological findings were examined, and all patients with posttransplant lymphoproliferative disorder were reclassified to World Health Organization 2008 lymphoma classification.
Only 27 of 2224 patients developed posttransplant lymphoproliferative disorder. The incidence of posttransplant lymphoproliferative disorder was 3.3-fold higher in children than in adults. The mean interval between transplant and diagnosis of posttransplant lymphoproliferative disorder was 65 months. Patients with tacrolimus were associated with a shorter posttransplant lymphoproliferative disorder development time compared with cyclosporine patients. Epstein-Barr virus-encoded small RNA positive showed shorter time for development of posttransplant lymphoproliferative disorder compared with Epstein-Barr virus-encoded small RNA negative patients. The risk of developing posttransplant lymphoproliferative disorder within the first year of transplant was higher in patients under tacrolimus protocol compared with patients under cyclosporine. Of 27 patients, 4 showed early lesion and 23 patients showed monomorphic posttransplant lymphoproliferative disorder. The development of T-cell monomorphic posttransplant lymphoproliferative disorder was significantly late compared with patients with B-cell monomorphic posttransplant lymphoproliferative disorder. Eight patients died at 38 ± 50 months after posttransplant lymphoproliferative disorder diagnosis. Four patients with early type posttransplant lymphoproliferative disorder were alive, and 3 of 4 patients with T-cell monomorphic posttransplant lymphoproliferative disorder died shortly after diagnosis. Five of 19 patients with B-cell monomorphic posttransplant lymphoproliferative disorder died at a mean 29 ± 18 months. A significant difference was found between the histologic types regarding patient survival. A significant difference was found between the Epstein-Barr virus-encoded small RNA positive and Epstein-Barr virus-encoded small RNA negative patients regarding mean survival time.
To decrease the incidence of posttransplant lymphoproliferative disorder, risk factors should be evaluated and new approaches must be derived for prophylaxis, diagnosis, and treatment.
我们评估了实体器官移植后淋巴组织增生性疾病。
纳入1985年至2013年间接受移植的所有2224例实体器官移植受者。检查临床病理结果，并将所有移植后淋巴组织增生性疾病患者重新分类为世界卫生组织2008年淋巴瘤分类。
2224例患者中仅27例发生移植后淋巴组织增生性疾病。儿童移植后淋巴组织增生性疾病的发病率比成人高3.3倍。移植至诊断移植后淋巴组织增生性疾病的平均间隔时间为65个月。与使用环孢素的患者相比，使用他克莫司的患者移植后淋巴组织增生性疾病的发病时间较短。与EB病毒编码的小RNA阴性患者相比，EB病毒编码的小RNA阳性患者移植后淋巴组织增生性疾病的发病时间较短。与使用环孢素方案的患者相比，使用他克莫司方案的患者在移植后第一年内发生移植后淋巴组织增生性疾病的风险更高。27例患者中，4例表现为早期病变，23例表现为单形性移植后淋巴组织增生性疾病。与B细胞单形性移植后淋巴组织增生性疾病患者相比，T细胞单形性移植后淋巴组织增生性疾病的发生明显较晚。8例患者在移植后淋巴组织增生性疾病诊断后38±50个月死亡。4例早期型移植后淋巴组织增生性疾病患者存活，4例T细胞单形性移植后淋巴组织增生性疾病患者中有3例在诊断后不久死亡。19例B细胞单形性移植后淋巴组织增生性疾病患者中有5例平均在29±18个月时死亡。在组织学类型之间发现患者生存率存在显著差异。在EB病毒编码的小RNA阳性和阴性患者之间发现平均生存时间存在显著差异。
为降低移植后淋巴组织增生性疾病的发病率，应评估危险因素，并必须探索预防、诊断和治疗的新方法。
