接受他克莫司治疗的小儿肝移植受者移植后嗜酸性粒细胞性胃肠疾病和淋巴增殖性疾病

Post-transplant eosinophilic gastrointestinal disorders and lymphoproliferative disorder in pediatric liver transplant recipients on tacrolimus.

作者信息

Wasuwanich Paul, Batsis Irini, Thawillarp Supharerk, Alford Mary K, Mogul Douglas, Wood Robert A, Karnsakul Wikrom

机构信息

University of Florida College of Medicine, Gainesville, FL, USA.

Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA.

出版信息

Transpl Immunol. 2021 Oct;68:101438. doi: 10.1016/j.trim.2021.101438. Epub 2021 Jul 25.

DOI:10.1016/j.trim.2021.101438

PMID:34320385

Abstract

AIM

To examine and characterize post-transplant eosinophilic gastrointestinal disorders (PTEGID) and post-transplant lymphoproliferative disorder (PTLD) in pediatric liver transplant recipients.

METHODS

This is a single center retrospective study of all liver transplant recipients aged 0-18 years from 1999 to 2019 who received tacrolimus as their primary immunosuppressant. Demographic data and clinical/laboratory data including PTEGID, PTLD, liver transplant types, Epstein-Barr virus status, and blood eosinophil count were reviewed. Analysis was done with logistic regression and Mann-Whitney U test.

RESULTS

Ninety-eight pediatric liver transplant recipients were included with median age at transplantation of 3.3 years (IQR: 1.1-9.3). The major indication for transplantation was biliary atresia, 51 (52%) cases. Eight (8%) children had PTLD and 14 (14%) had PTEGID. Receiving liver transplantation at an age of ≤1 year was associated with developing PTEGID (OR = 11.9, 95% CI = 3.5-45.6, p < 0.001). Additionally, eosinophilic count of ≥500/μL was associated with having PTLD (OR = 10.7, 95% CI = 1.8-206.0, p = 0.030) as well as having at least one liver rejection (OR = 2.8, 95% CI = 1.2-7.0, p = 0.024). The frequency of food-induced anaphylaxis significantly increased post-transplantation (p = 0.023).

CONCLUSIONS

PTEGID and PTLD are common in this cohort and are associated with certain risk factors that help screen children to improve recipient survival. Further studies are needed to evaluate the clinical benefits of these findings.

摘要

目的

研究并描述小儿肝移植受者移植后嗜酸性粒细胞性胃肠疾病（PTEGID）和移植后淋巴细胞增生性疾病（PTLD）的情况。

方法

这是一项单中心回顾性研究，研究对象为1999年至2019年间接受他克莫司作为主要免疫抑制剂的所有0至18岁肝移植受者。回顾了人口统计学数据以及包括PTEGID、PTLD、肝移植类型、EB病毒状态和血液嗜酸性粒细胞计数在内的临床/实验室数据。采用逻辑回归和曼-惠特尼U检验进行分析。

结果

纳入98例小儿肝移植受者，移植时的中位年龄为3.3岁（四分位间距：1.1 - 9.3）。移植的主要指征是胆道闭锁，共51例（52%）。8例（8%）儿童发生PTLD，14例（14%）发生PTEGID。1岁及以下接受肝移植与发生PTEGID相关（比值比=11.9，95%置信区间=3.5 - 45.6，p<0.001）。此外，嗜酸性粒细胞计数≥500/μL与发生PTLD相关（比值比=10.7，95%置信区间=1.8 - 206.0，p=0.030）以及与至少发生一次肝排斥反应相关（比值比=2.8，95%置信区间=1.2 - 7.0，p=0.024）。移植后食物诱导的过敏反应频率显著增加（p=0.023）。