Meharry Medical College, Nashville, Tennessee, USA.
Division of Pediatric Cardiology, Johns Hopkins All Children's Hospital, Saint Petersburg, Florida, USA.
Clin Transplant. 2023 Sep;37(9):e15015. doi: 10.1111/ctr.15015. Epub 2023 May 26.
Post-transplant lymphoproliferative disorder (PTLD) is a serious complication of pediatric heart transplant (PHTx). 18F-FDG PET/CT has been used to differentiate early lympho-proliferation from more advanced PTLD. We report our experience with PET/CT in the management of PTLD following PHTx.
This was a retrospective study of 100 consecutive PHTx recipients at our institution between 2004 and 2018. Patients who underwent PET/CT or conventional CT scans to evaluate for PTLD or high Epstein-Barr viral load were included.
Males, eight females. Median age at transplant was 3.5 months (IQR = 1.5-27.5). Median age at PTLD diagnosis was 13.3 years (IQR = 9.2-16.1). Median time between transplant and PTLD diagnosis was 9.5 (IQR = 4.5-15) years. Induction agents were used in 12 patients (50%): Thymoglobulin (N = 9), anti-IL2 (N = 2), and Rituximab (N = 1). Eighteen patients (75%) had PET/CT, of whom 14 had 18FDG-avid PTLD. Six had conventional CT. Nineteen patients (79.2%) had diagnostic biopsy confirmation of PTLD, and 5 (20.8%) had excisional biopsies. Two patients had Hodgkin's lymphoma; nine had monomorphic PTLD; eight had polymorphic PTLD; five were classified as other. Nine patients had monomorphic PTLD, including seven with diffuse large cell lymphoma (DLBC) and one with T cell lymphoma. The majority (16/24) had multi-site involvement at PTLD diagnosis, and PET/CT showed that 31.3% (5/16) had easily accessible subcutaneous nodes. Seventeen patients (overall survival 71%) underwent successful treatment without recurrence of PTLD. Of seven deaths (7/24, 29%), five had DLBC lymphoma, one had polymorphic PTLD and one had T-cell lymphoma.
PET-CT allowed simultaneous anatomical and functional assessment of PTLD lesions, while guiding biopsy. In patients with multiple lesions, PET/CT revealed the most prominent and active lesions, improving diagnostic accuracy.
移植后淋巴组织增生性疾病（PTLD）是小儿心脏移植（PHTx）的严重并发症。18F-FDG PET/CT 已用于区分早期淋巴增生与更晚期的 PTLD。我们报告了我们在 PHTx 后使用 PET/CT 管理 PTLD 的经验。
这是一项对 2004 年至 2018 年间我院 100 例连续 PHTx 受者进行的回顾性研究。纳入了接受 PET/CT 或常规 CT 扫描以评估 PTLD 或高 Epstein-Barr 病毒载量的患者。
男性 8 例，女性 2 例。移植时的中位年龄为 3.5 个月（IQR=1.5-27.5）。PTLD 诊断时的中位年龄为 13.3 岁（IQR=9.2-16.1）。移植与 PTLD 诊断之间的中位时间为 9.5 年（IQR=4.5-15）。12 例患者（50%）使用了诱导剂：Thymoglobulin（N=9）、抗-IL2（N=2）和利妥昔单抗（N=1）。18 例患者（75%）进行了 PET/CT，其中 14 例有 18FDG 阳性的 PTLD。6 例进行了常规 CT。19 例患者（79.2%）经诊断性活检证实为 PTLD，5 例（20.8%）为切除性活检。2 例患者为霍奇金淋巴瘤；9 例为单形性 PTLD；8 例为多形性 PTLD；5 例为其他。9 例患者为单形性 PTLD，其中 7 例为弥漫性大 B 细胞淋巴瘤（DLBC），1 例为 T 细胞淋巴瘤。大多数患者（16/24）在 PTLD 诊断时就有多处受累，PET/CT 显示 31.3%（5/16）有易于触及的皮下淋巴结。17 例患者（总生存率 71%）接受了成功的治疗，且没有复发。7 例死亡患者（7/24，29%）中，5 例为 DLBC 淋巴瘤，1 例为多形性 PTLD，1 例为 T 细胞淋巴瘤。
PET-CT 允许同时对 PTLD 病变进行解剖和功能评估，同时指导活检。对于有多发病灶的患者，PET/CT 显示了最突出和活跃的病变，提高了诊断准确性。
