Kumar Deepali, Patil Nikhil, Husain Shahid, Chaparro Cecilia, Bhat Mamatha, Kim S Joseph, Humar Atul
Multi Organ Transplant Program, University Health Network, Toronto, ON, Canada.
Clin Transplant. 2017 Jul;31(7). doi: 10.1111/ctr.13000. Epub 2017 Jun 1.
Epstein-Barr virus (EBV) D+/R- organ transplant recipients are a high-risk group for developing post-transplant lymphoproliferative disease (PTLD). Little data are available for prevention in the adult EBV mismatched population. We conducted a retrospective study of EBV D+/R- organ transplants performed during 2002-2014. Of the 153 patients identified, 82.4% patients received antiviral prophylaxis with valganciclovir for a median of 4.5 months (range: 0.8-22 months) and 36.6% underwent viral load monitoring in the first post-transplant year. EBV viremia developed in 67.2% monitored patients. In viremic patients, immunosuppression was reduced in 20/37(54.1%) in response to viremia and 17/37 (45.9%) received therapeutic dose valganciclovir. In patients with EBV viremia who received valganciclovir and/or had a reduction in immunosuppression and had sufficient viral load time points (n=31), 28 (90.3%) had a significant decline in viral load at day 14 (median log decline 0.49 (0.24-0.64), P<.001) and at day 30 (0.87 (0.52-1.21), P<.001). PTLD developed in 27 (15%) patients (biopsy proven=25, possible=2) at median 8 months (range: 2.4-130) post-transplant with the majority (81.5%) within the first year. In multivariate analysis, viral load monitoring and use of mycophenolate were associated with a lower incidence of PTLD. Antiviral prophylaxis was not associated with a lower risk of PTLD, but viral load monitoring and use of mycophenolate mofetil were protective.
爱泼斯坦-巴尔病毒（EBV）D+/R-器官移植受者是发生移植后淋巴细胞增生性疾病（PTLD）的高危人群。关于成人EBV配型不合人群预防方面的数据很少。我们对2002年至2014年期间进行的EBV D+/R-器官移植进行了一项回顾性研究。在确定的153例患者中，82.4%的患者接受了缬更昔洛韦抗病毒预防，中位时间为4.5个月（范围：0.8至22个月），36.6%的患者在移植后的第一年进行了病毒载量监测。67.2%接受监测的患者发生了EBV病毒血症。在病毒血症患者中，20/37（54.1%）因病毒血症而降低了免疫抑制，17/37（45.9%）接受了治疗剂量的缬更昔洛韦。在接受缬更昔洛韦和/或免疫抑制降低且有足够病毒载量时间点的EBV病毒血症患者中（n = 31），28例（90.3%）在第14天病毒载量显著下降（中位对数下降0.49（0.24 - 0.64），P <.001），在第30天下降（0.87（0.52 - 1.21），P <.001）。27例（15%）患者发生了PTLD（活检证实 = 25例，可能 = 2例），移植后中位时间为8个月（范围：2.4至130个月），大多数（81.5%）在第一年内发生。在多变量分析中，病毒载量监测和霉酚酸酯的使用与PTLD的较低发生率相关。抗病毒预防与PTLD的较低风险无关，但病毒载量监测和霉酚酸酯的使用具有保护作用。
