Dos Santos Quenia, Wareham Neval Ete, Mocroft Amanda, Rasmussen Allan, Gustafsson Finn, Perch Michael, Sørensen Søren Schwartz, Manuel Oriol, Müller Nicolas J, Lundgren Jens, Reekie Joanne
Centre of Excellence for Health, Immunity and Infections (CHIP), Rigshospitalet, University of Copenhagen, 2100 Copenhagen, Denmark.
Centre for Clinical Research, Epidemiology, Modelling and Evaluation (CREME), Institute for Global Health, University College London, London WC1E6BT, UK.
Cancers (Basel). 2022 Jul 4;14(13):3279. doi: 10.3390/cancers14133279.
Post-transplant lymphoproliferative disease (PTLD) is a well-recognized complication after transplant. This study aimed to develop and validate a risk score to predict PTLD among solid organ transplant (SOT) recipients. Poisson regression identified predictors of PTLD with the best fitting model selected for the risk score. The derivation cohort consisted of 2546 SOT recipients transpanted at Rigshospitalet, Copenhagen between 2004 and 2019; 57 developed PTLD. Predictors of PTLD were high-risk pre-transplant Epstein-Barr Virus (EBV), IgG donor/recipient serostatus, and current positive plasma EBV DNA, abnormal hemoglobin and C-reactive protein levels. Individuals in the high-risk group had almost 7 times higher incidence of PTLD (incidence rate ratio (IRR) 6.75; 95% CI: 4.00-11.41) compared to the low-risk group. In the validation cohort of 1611 SOT recipients from the University Hospital of Zürich, 24 developed PTLD. A similar 7 times higher risk of PTLD was observed in the high-risk group compared to the low-risk group (IRR 7.17, 95% CI: 3.05-16.82). The discriminatory ability was also similar in derivation (Harrell's C-statistic of 0.82 95% CI (0.76-0.88) and validation (0.82, 95% CI:0.72-0.92) cohorts. The risk score had a good discriminatory ability in both cohorts and helped to identify patients with higher risk of developing PTLD.
移植后淋巴细胞增生性疾病（PTLD）是移植后一种公认的并发症。本研究旨在开发并验证一种风险评分，以预测实体器官移植（SOT）受者发生PTLD的风险。泊松回归确定了PTLD的预测因素，并选择了拟合度最佳的模型用于风险评分。推导队列包括2004年至2019年在哥本哈根里格霍斯皮塔尔接受移植的2546名SOT受者；其中57人发生了PTLD。PTLD的预测因素包括移植前高危型爱泼斯坦-巴尔病毒（EBV）、IgG供体/受者血清学状态、当前血浆EBV DNA阳性、血红蛋白异常和C反应蛋白水平。与低风险组相比，高风险组个体发生PTLD的发生率几乎高7倍（发病率比（IRR）为6.75；95%置信区间：4.00-11.41）。在苏黎世大学医院的1611名SOT受者的验证队列中，24人发生了PTLD。与低风险组相比，高风险组发生PTLD的风险同样高7倍（IRR为7.17，95%置信区间：3.05-16.82）。推导队列（Harrell's C统计量为0.82，95%置信区间（0.76-0.88））和验证队列（0.82，95%置信区间：0.72-0.92）的鉴别能力也相似。该风险评分在两个队列中均具有良好的鉴别能力，有助于识别发生PTLD风险较高的患者。
