Colombini Elisa, Guzzo Isabella, Morolli Federica, Longo Germana, Russo Cristina, Lombardi Alessandra, Merli Pietro, Barzon Luisa, Murer Luisa, Piga Simone, Ciofi Degli Atti Marta Luisa, Locatelli Franco, Dello Strologo Luca
Pediatric Nephrology and Renal Transplant Unit, Bambino Gesù Children's Hospital-IRCCS, Piazza S. Onofrio 4, 00165, Rome, Italy.
Pediatric Nephrology, Dialysis and Transplantation Unit, Department of Pediatrics, University of Padova, Padova, Italy.
Pediatr Nephrol. 2017 Aug;32(8):1433-1442. doi: 10.1007/s00467-017-3627-2. Epub 2017 Mar 9.
Post-transplant lymphoproliferative disorder (PTLD) is a severe complication of solid organ transplantation that can be classified into two major subtypes, namely, early lesions and non-early lesions, based on histopathological findings. In the vast majority of cases, proliferating cells are B lymphocytes and, most frequently, proliferation is induced by Epstein-Barr virus (EBV) infection.
The aim of our study was to evaluate the natural history of EBV infection and its possible evolution toward PTLD in a pediatric cohort of patients who received a renal transplant between January 2000 and December 2013. A total of 304 patients were evaluated for this study, of whom 103 tested seronegative for EBV at transplantation.
Following transplantation, 50 of the 103 seronegative patients (48.5%) developed a first EBV infection, based on the results of PCR assays for EBV DNA, with 19 of these patients ultimately reverting to the negative state (<3000 copies/ml). Among the 201 seropositive patients only 40 (19.9%) presented a reactivation of EBV. Non-early lesions PTLD was diagnosed in ten patients, and early lesions PTLD was diagnosed in five patients. In all cases a positive EBV viral load had been detected at some stage of the follow-up. Having a maximum peak of EBV viral load above the median value observed in the whole cohort (59,909.5 copies/ml) was a significant and independent predictor of non-early lesions PTLD and all PTLD onset.
A high PCR EBV viral load is correlated with the probability of developing PTLD. The definition of a reliable marker is essential to identify patients more at risk of PTLD and to personalize the clinical approach to the single patient.
移植后淋巴细胞增生性疾病（PTLD）是实体器官移植的一种严重并发症，根据组织病理学结果可分为两种主要亚型，即早期病变和非早期病变。在绝大多数病例中，增殖细胞为B淋巴细胞，最常见的是由爱泼斯坦-巴尔病毒（EBV）感染诱导增殖。
我们研究的目的是评估2000年1月至2013年12月期间接受肾移植的儿科患者队列中EBV感染的自然史及其向PTLD发展的可能演变。本研究共评估了304例患者，其中103例在移植时EBV血清学检测为阴性。
移植后，根据EBV DNA的PCR检测结果，103例血清学阴性患者中有50例（48.5%）发生了首次EBV感染，其中19例患者最终恢复为阴性状态（<3000拷贝/ml）。在201例血清学阳性患者中，只有40例（19.9%）出现了EBV再激活。10例患者被诊断为非早期病变PTLD，5例患者被诊断为早期病变PTLD。在所有病例中，随访的某个阶段均检测到EBV病毒载量阳性。EBV病毒载量的最大峰值高于整个队列中观察到的中位数（59,909.5拷贝/ml）是发生非早期病变PTLD和所有PTLD发病的显著且独立的预测因素。
高PCR EBV病毒载量与发生PTLD的可能性相关。定义一个可靠的标志物对于识别更易患PTLD的患者以及针对个体患者制定个性化的临床治疗方法至关重要。
