Department of Pediatrics, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Department of Pediatrics, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea.
J Korean Med Sci. 2019 Aug 5;34(30):e203. doi: 10.3346/jkms.2019.34.e203.
Post-transplant lymphoproliferative disease (PTLD) is one of the major complications of organ transplantation, especially in children with Epstein-Barr virus (EBV) viremia (EV). We performed a retrospective study to evaluate risk factors for PTLD in children with EV.
Among 199 pediatric kidney transplantation (KT) recipients at our center from January 2001 to October 2015, records of those with EBV viral loads of > 1,000 copies/mL and/or PTLD were reviewed.
Diagnosis of PTLD was made in seven patients (PTLD group), and 39 patients had EV only (EV only group). The median time from KT to EV and PTLD diagnosis was 6.7 (range 0.4-47.8) months and 8.2 (range, 2.8-98.9) months, respectively. There were no significant differences between the groups in terms of sex, age at transplantation, donor type, EBV viral load, or EV-free duration after KT. Higher tacrolimus level before EV (hazard ratio, 44.5; P = 0.003) was an independent risk factor for PTLD in multivariate Cox regression analysis. Six patients with a high EBV load (median 171,639 copies/mL) were treated with preemptive rituximab (RTX) therapy, resulting in transient reduction of EBV load. None of these patients developed PTLD (median follow-up 51.5 months); however, two had neutropenia and two developed infection requiring hospital admission.
In pediatric KT recipients, higher tacrolimus levels were associated with a higher incidence of PTLD. Conversely, those who received preemptive RTX for EV did not develop PTLD.
移植后淋巴组织增生性疾病（PTLD）是器官移植的主要并发症之一，尤其是在儿童中存在 EBV 病毒血症（EV）时。我们进行了一项回顾性研究，以评估 EV 儿童中发生 PTLD 的危险因素。
在我们中心的 199 例儿科肾移植（KT）受者中，对 EBV 病毒载量>1000 拷贝/mL 和/或有 PTLD 的患者进行了回顾性分析。
7 例患者（PTLD 组）诊断为 PTLD，39 例患者仅有 EV（仅 EV 组）。从 KT 到 EV 和 PTLD 诊断的中位时间分别为 6.7（范围 0.4-47.8）个月和 8.2（范围 2.8-98.9）个月。两组在性别、移植时年龄、供体类型、EBV 病毒载量或 KT 后 EV 无持续时间方面无显著差异。多变量 Cox 回归分析显示，EV 前较高的他克莫司水平（危险比，44.5；P=0.003）是 PTLD 的独立危险因素。6 例 EBV 高载量（中位载量 171639 拷贝/mL）患者接受了抢先利妥昔单抗（RTX）治疗，导致 EBV 载量短暂下降。这些患者均未发生 PTLD（中位随访 51.5 个月）；然而，2 例患者出现中性粒细胞减少症，2 例患者发生感染需要住院治疗。
在儿科 KT 受者中，较高的他克莫司水平与 PTLD 的发生率较高相关。相反，那些因 EV 接受抢先 RTX 治疗的患者未发生 PTLD。
