Sydney School of Public Health, University of Sydney, Camperdown, Victoria, Australia.
Child and Adolescent Renal Service, Children's Health Queensland, Brisbane, Queensland, Australia.
Nephrol Dial Transplant. 2018 May 1;33(5):881-889. doi: 10.1093/ndt/gfx356.
Differences in the epidemiology of post-transplant lymphoproliferative disease (PTLD) between adult and paediatric kidney transplant recipients remain unclear.
Using the Australian and New Zealand Dialysis and Transplant Registry (1963-2015), the cumulative incidences of PTLD in children (age <20 years) and adults were calculated using a competing risk of death model and compared with age-matched population-based data using standardized incidence ratios (SIRs). Risk factors for PTLD were assessed using Cox proportional hazards regression.
Among 23 477 patients (92% adult, 60% male), 505 developed PTLD, with 50 (10%) occurring in childhood recipients. The 25-year cumulative incidence of PTLD was 3.3% [95% confidence interval (CI) 2.9-3.6] for adult recipients and 3.6% (95% CI 2.7-4.8) for childhood recipients. Childhood recipients had a 30-fold increased risk of lymphoma compared with the age-matched general population [SIR 29.5 (95% CI 21.9-38.8)], higher than adult recipients [SIR 8.4 (95% CI 7.7-9.2)]. Epstein-Barr virus (EBV)-negative recipient serology [adjusted hazard ratio (aHR) 3.33 (95% CI 2.21-5.01), P < 0.001], year of transplantation [aHR 0.93 for each year after the year 2000 (95% CI 0.88-0.99), P = 0.02], induction with an agent other than anti-CD25 monoclonal antibody [aHR 2.07 (95% CI 1.16-3.70), P = 0.01] and having diabetes [aHR 3.49 (95% CI 2.26-5.38), P < 0.001] were independently associated with PTLD.
Lymphoma occurs at similar rates in adult and paediatric recipients, but has been decreasing since the year 2000. EBV-negative patients and those with diabetes or induction agent other than anti-CD25 monoclonal antibody are at substantially increased risk of PTLD.
成人和儿童肾移植受者移植后淋巴组织增生性疾病（PTLD）的流行病学差异仍不清楚。
利用澳大利亚和新西兰透析和移植登记处（1963-2015 年），使用竞争死亡风险模型计算儿童（<20 岁）和成人的 PTLD 累积发生率，并使用标准化发病率比（SIR）与年龄匹配的基于人群的数据进行比较。使用 Cox 比例风险回归评估 PTLD 的危险因素。
在 23477 名患者（92%为成人，60%为男性）中，有 505 名发生了 PTLD，其中 50 名（10%）发生在儿童受者中。成人受者 25 年累积 PTLD 发生率为 3.3%（95%CI 2.9-3.6），儿童受者为 3.6%（95%CI 2.7-4.8）。与年龄匹配的一般人群相比，儿童受者发生淋巴瘤的风险增加了 30 倍[SIR 29.5（95%CI 21.9-38.8）]，高于成人受者[SIR 8.4（95%CI 7.7-9.2）]。EB 病毒（EBV）阴性受者血清学[校正风险比（aHR）3.33（95%CI 2.21-5.01），P<0.001]、移植年份[aHR 每增加 1 年（95%CI 0.88-0.99），P=0.02]、非抗 CD25 单克隆抗体诱导剂[aHR 2.07（95%CI 1.16-3.70），P=0.01]和糖尿病[aHR 3.49（95%CI 2.26-5.38），P<0.001]与 PTLD 独立相关。
淋巴瘤在成人和儿童受者中的发生率相似，但自 2000 年以来呈下降趋势。EBV 阴性患者以及患有糖尿病或非抗 CD25 单克隆抗体诱导剂的患者发生 PTLD 的风险显著增加。
