Franceschini Erica, Plessi Jessica, Zona Stefano, Santoro Antonella, Digaetano Margherita, Fontana Francesco, Alfano Gaetano, Guaraldi Giovanni, Comoli Patrizia, Facchini Francesca, Potenza Leonardo, Gennari William, Codeluppi Mauro, Luppi Mario, Cappelli Gianni, Gyssens Inge C, Mussini Cristina
Clinic of Infectious Diseases, Azienda Ospedaliero-Universitaria Policlinico, Modena, Italy.
Clinic of Nephrology, University of Modena and Reggio Emilia, Modena, Italy.
Transplant Direct. 2017 Jun 26;3(7):e182. doi: 10.1097/TXD.0000000000000703. eCollection 2017 Jul.
Posttransplant lymphoproliferative disease (PTLD) is an important cause of morbidity and mortality in solid organ transplants. Epstein Barr virus (EBV) plays a major role in PTLD development. Guidelines recommend EBV viral load (VL) monitoring in high-risk populations in the first year.
Retrospective observational study in all adult patients who had at least 1 EBV-VL performed in the postkidney transplant (KT) period from January 2005 to December 2014 at the Policlinico Modena Hospital. We compared patients with negative EBV-DNA to patients with positive EBV-DNA and we described PTLD developed in the study period.
One hundred ninety (36.3%) KT patients of 523 were screened for EBV-DNA with 796 samples. One hundred twenty-eight (67.4%) of 190 tested patients presented at least 1 positive sample for EBV. Older age, the use of sirolimus, everolimus, and steroids were associated with EBV-DNA positivity in the univariate analysis. Nine (1.7%) of 523 patients had PTLD. Incidence rate of PTLD in the KT cohort was 0.19/100 person year follow-up (95% confidence interval, 0.09-0.37). One of 9 patients developed early PTLD and was a high-risk patient. Only this PTLD case was positive for EBV. No PTLD case had an EBV-VL superior to 4000 copies/mL.
Our results suggest that the keystone of PTLD diagnosis is the clinical suspicion. Our study suggests that, in line with guidelines, EBV-VL assays may be avoided in low-risk patients in the absence of a strong clinical PTLD suspicion without increasing patients' risk of developing PTLD. This represents a safe and cost-saving clinical strategy for our center.
移植后淋巴细胞增生性疾病（PTLD）是实体器官移植中发病和死亡的重要原因。爱泼斯坦-巴尔病毒（EBV）在PTLD的发生中起主要作用。指南建议在第一年对高危人群进行EBV病毒载量（VL）监测。
对2005年1月至2014年12月在摩德纳综合医院进行肾移植（KT）术后至少进行过1次EBV-VL检测的所有成年患者进行回顾性观察研究。我们将EBV-DNA阴性的患者与EBV-DNA阳性的患者进行比较，并描述了研究期间发生的PTLD。
523例KT患者中有190例（36.3%）接受了EBV-DNA筛查，共检测796份样本。190例检测患者中有128例（67.4%）至少有1份EBV阳性样本。在单因素分析中，年龄较大、使用西罗莫司、依维莫司和类固醇与EBV-DNA阳性相关。523例患者中有9例（1.7%）发生PTLD。KT队列中PTLD的发病率为0.19/100人年随访（95%置信区间，0.09 - 0.37）。9例患者中有1例发生早期PTLD，为高危患者。仅该PTLD病例EBV阳性。没有PTLD病例的EBV-VL超过4000拷贝/mL。
我们的结果表明，PTLD诊断的关键是临床怀疑。我们的研究表明，与指南一致，在没有强烈的临床PTLD怀疑的情况下，低风险患者可以避免进行EBV-VL检测，而不会增加患者发生PTLD的风险。这对我们中心来说是一种安全且节省成本的临床策略。
