Maksten Eva Futtrup, Vase Maja Ølholm, Kampmann Jan, d'Amore Francesco, Møller Michael Boe, Strandhave Charlotte, Bendix Knud, Bistrup Claus, Thiesson Helle Charlotte, Søndergaard Esben, Hamilton-Dutoit Stephen, Jespersen Bente
Department of Renal Medicine, Aarhus University Hospital, Aarhus N, Denmark.
Department of Haematology, Aarhus University Hospital, Aarhus C, Denmark.
Transpl Int. 2016 Apr;29(4):483-93. doi: 10.1111/tri.12744. Epub 2016 Feb 18.
Post-transplant lymphoproliferative disorder (PTLD) incidence is difficult to determine, mainly because both early and other lesions may go unrecognized and unregistered. Few studies have included systematic pathology review to maximize case identification and decide more accurately PTLD frequency after long-term post-transplantation follow-up. A retrospective population-based cohort study including all kidney transplant recipients at two Danish centres (1990-2011; population covered 3.1 million; 2175 transplantations in 1906 patients). Pathology reports were reviewed for all patient biopsies to identify possible PTLDs. Candidate PTLDs underwent histopathological review and classification. Seventy PTLD cases were identified in 2175 transplantations (3.2%). The incidence rate (IR) after first transplantation was 5.4 cases per 1000 patient-years (95% CI: 4.0-7.3). Most PTLDs were monomorphic (58.5%), or early lesions (21.5%). Excluding early lesions and patients <18 years, IR was 3.7 (95% CI: 2.9-5.5). Ten patients with PTLD were retransplanted, 2 developing further PTLDs. Post-transplant patient survival was inferior in patients with PTLD, while death-censored graft survival was not. Using registry data together with extensive pathological review and long follow-up, a rather high incidence of PTLD was found.
移植后淋巴细胞增生性疾病（PTLD）的发病率难以确定，主要是因为早期病变和其他病变可能未被识别和记录。很少有研究纳入系统的病理学检查，以最大限度地识别病例，并在长期移植后随访后更准确地确定PTLD的发生率。一项基于人群的回顾性队列研究，纳入了丹麦两个中心的所有肾移植受者（1990 - 2011年；覆盖人群310万；1906例患者进行了2175次移植）。对所有患者活检的病理报告进行审查，以识别可能的PTLD。候选PTLD病例接受组织病理学检查和分类。在2175次移植中识别出70例PTLD病例（3.2%）。首次移植后的发病率为每1000患者年5.4例（95%可信区间：4.0 - 7.3）。大多数PTLD为单形性（58.5%）或早期病变（21.5%）。排除早期病变和<18岁的患者后，发病率为3.7（95%可信区间：2.9 - 5.5）。10例PTLD患者接受了再次移植，其中2例出现了进一步的PTLD。PTLD患者的移植后患者生存率较低，而死亡截尾的移植物生存率则不然。通过使用登记数据以及广泛的病理学检查和长期随访，发现PTLD的发病率相当高。
