Huang James Guoxian, Tan Mervin Ye Qing, Quak Seng-Hock, Aw Marion Margaret
Khoo Teck Puat - National University Children's Medical Institute, National University Health System, Singapore.
Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
Transpl Infect Dis. 2018 Feb;20(1). doi: 10.1111/tid.12798. Epub 2017 Nov 28.
We aimed to evaluate clinical characteristics, risk factors, and disease outcomes for liver transplant recipients (LTR) with post-transplant lymphoproliferative disease (PTLD) at our center.
Retrospective review of data of all pediatric LTR (1991-2015) was conducted.
The overall incidence of PTLD was 16.4% (18/110), the majority (13/18) were early lesions, while 3/18 were polymorphic/monomorphic PTLD. The risk factors significant on univariate analysis were as follows: mean age (years) at transplant (1.66 vs 4.76, P = .006); age <2 years at transplant (odds ratio [OR] 3.53 [95% confidence interval [CI]: 1.16-10.73], P = .026); cytomegalovirus (CMV) primary infection (OR 11.39 [95% CI: 3.44-37.7], P < .001); recipient CMV seronegativity (OR 7.50 [95% CI: 2.02-27.78], P = .003); presence of CMV end-organ disease (OR 4.00 [95% CI: 1.22-13.16], P = .022); Chinese ethnicity; and higher mean duration of intravenous ganciclovir prophylaxis. In multivariate analysis, CMV primary infection (OR 5.22 [95% CI: 1.25-21.87], P = .024), CMV seronegativity (OR 5.91 [95% CI: 1.13-30.90, P = .035]), and having acute cellular rejections (ACR) prior to PTLD (OR 5.53 [95% CI: 1.43-21.48, P = .013]) were significant risk factors for PTLD, with the latter two factors having a synergistic effect in increasing PTLD risk in a stratified analysis. The final multivariate model in predicting the risk of PTLD, utilizing CMV primary infection, recipient CMV seronegativity, and ACR before PTLD as predictive variables, was statistically significant (likelihood ratio chi square statistic = 25.18, P < .0001 with df = 3).
We report a unique clinicopathologic and risk factor profile in our cohort-early lesion PTLD accounts for the majority and the incidence of monomorphic PTLD remains low. In addition, we show a synergism between CMV naivety and ACR on PTLD risk, a higher prevalence of gastrointestinal manifestations, and a lack of significant association with Epstein-Barr virus seronegativity.
我们旨在评估我院肝移植受者（LTR）发生移植后淋巴细胞增生性疾病（PTLD）的临床特征、危险因素及疾病转归。
对所有小儿肝移植受者（1991 - 2015年）的数据进行回顾性分析。
PTLD的总体发生率为16.4%（18/110），大多数（13/18）为早期病变，而3/18为多形性/单形性PTLD。单因素分析中有显著意义的危险因素如下：移植时的平均年龄（岁）（1.66对4.76，P = 0.006）；移植时年龄<2岁（比值比[OR] 3.53 [95%置信区间[CI]：1.16 - 10.73]，P = 0.026）；巨细胞病毒（CMV）原发感染（OR 11.39 [95% CI：3.44 - 37.7]，P < 0.001）；受者CMV血清学阴性（OR 7.50 [95% CI：2.02 - 27.78]，P = 0.003）；存在CMV终末器官疾病（OR 4.00 [95% CI：1.22 - 13.16]，P = 0.022）；华裔；以及更长期的静脉用更昔洛韦预防性治疗。多因素分析中，CMV原发感染（OR 5.22 [95% CI：1.25 - 21.87]，P = 0.024）、CMV血清学阴性（OR 5.91 [95% CI：1.13 - 30.90，P = 0.035]）和在PTLD之前发生急性细胞排斥反应（ACR）（OR 5.53 [95% CI：1.43 - 21.48，P = 0.013]）是PTLD的显著危险因素，在分层分析中后两个因素在增加PTLD风险方面具有协同作用。利用CMV原发感染、受者CMV血清学阴性和PTLD之前的ACR作为预测变量来预测PTLD风险的最终多因素模型具有统计学意义（似然比卡方统计量 = 25.18，P < 0.0001，自由度 = 3）。
我们报告了我们队列中独特的临床病理和危险因素特征——早期病变PTLD占大多数，单形性PTLD的发生率仍然较低。此外，我们显示CMV血清学阴性和ACR在PTLD风险上具有协同作用，胃肠道表现的患病率较高，且与EB病毒血清学阴性无显著关联。
