Wójciak M, Gozdowska J, Dęborska-Materkowska D, Perkowska-Ptasińska A, Kosieradzki M, Nazarewski S, Durlik M
Department of Transplantation Medicine, Nephrology and Internal Diseases, Medical University of Warsaw, Warsaw, Poland.
Department of Transplantation Medicine, Nephrology and Internal Diseases, Medical University of Warsaw, Warsaw, Poland.
Transplant Proc. 2018 Sep;50(7):2154-2158. doi: 10.1016/j.transproceed.2018.02.168. Epub 2018 Mar 13.
Posttransplant lymphoproliferative disorder (PTLD) is a heterogeneous group of lymphoid malignant neoplasms arising after solid organ transplantation or hematopoietic stem cell transplantation. The current World Health Organization classification identified 4 basic histologic types of PTLD: early, polymorphic variant, monomorphic variant, and classical Hodgkin lymphoma-type lesions.
Data of 12 PTLD cases of was retrospectively analyzed in terms of the transplanted organs, time to diagnosis of PTLD, type of immunosuppressive treatment in regard to the induction treatment and acute transplant rejection, and long-term survival.
Most of the analyzed cases of PTLD occurred in men (n = 8, 67%); 83% of patients were renal transplant recipients and 17% were liver transplant recipients. Of the kidney recipients, 8% received induction of antithymocyte globulin and 17% received daclizumab. An episode of acute rejection occurred in 6 (50%) patients. All patients were treated with pulses of methylprednisolone and received triple immunosuppressive regimen. Histopathologic examination revealed polymorphic form of PTLD in 5 (42%) patients and classical Hodgkin lymphoma in 3 (25%) cases. Diffuse large B-cell lymphoma was diagnosed in 3 (25%) patients, and diffuse large B-cell lymphoma rich in T lymphocytes and histiocytes was diagnosed in 1 (8%) patient. ALK4- anaplastic lymphoma was diagnosed in 1 (8%) recipient. Four (25%) patients died as a result of PTLD progression (including all 3 patients with central nervous system involvement), and 8 survived with stable graft function.
PTLD is a heterogeneous group of lymphoproliferative disorders occurring in organ recipients. The unusual location changes (especially central nervous system or intestine) can impede the proper diagnosis.
移植后淋巴细胞增生性疾病（PTLD）是实体器官移植或造血干细胞移植后发生的一组异质性淋巴恶性肿瘤。世界卫生组织目前的分类确定了PTLD的4种基本组织学类型：早期、多形性变异型、单形性变异型和经典霍奇金淋巴瘤样病变。
回顾性分析12例PTLD病例的数据，内容包括移植器官、PTLD诊断时间、诱导治疗和急性移植排斥反应方面的免疫抑制治疗类型以及长期生存情况。
分析的PTLD病例大多发生在男性（n = 8，67%）；83%的患者是肾移植受者，17%是肝移植受者。在肾移植受者中，8%接受了抗胸腺细胞球蛋白诱导治疗，17%接受了达利珠单抗治疗。6例（50%）患者发生了急性排斥反应。所有患者均接受了甲泼尼龙冲击治疗，并采用三联免疫抑制方案。组织病理学检查显示，5例（42%）患者为多形性PTLD，3例（25%）为经典霍奇金淋巴瘤。3例（25%）患者被诊断为弥漫性大B细胞淋巴瘤，1例（8%）患者被诊断为富含T淋巴细胞和组织细胞的弥漫性大B细胞淋巴瘤。1例（8%）受者被诊断为ALK4-间变性淋巴瘤。4例（25%）患者因PTLD进展死亡（包括所有3例有中枢神经系统受累的患者），8例患者存活且移植肾功能稳定。
PTLD是器官移植受者中发生的一组异质性淋巴细胞增生性疾病。不寻常的部位改变（尤其是中枢神经系统或肠道）会妨碍正确诊断。
