Department of Gastroenterology and Hepatology, LUMC Transplantation Center, Leiden University Medical Center, Leiden, The Netherlands.
Department of Surgery, LUMC Transplantation Center, Leiden University Medical Center, Leiden, The Netherlands.
Liver Transpl. 2024 Jun 1;30(6):640-646. doi: 10.1097/LVT.0000000000000256. Epub 2023 Sep 13.
Post-transplant lymphoproliferative disease (PTLD) is a rare but serious complication of liver transplantation (LT) with morbidity and mortality. The risk factors for PTLD in adults are ill-defined. This study aimed to assess the risk factors for PTLD after LT in adults. All adult LT recipients between 1986 and 2016 from 2 centers in the Netherlands were included, with follow-up until 2020. PTLD was diagnosed according to the World Health Organization (WHO) classification. Potential risk factors for PTLD were assessed using multivariate Cox regression analysis. A total of 1281 patients were included, of whom 29 (2.3%) developed PTLD. Results show that independent risk factors for PTLD after LT in adults were no Epstein-Barr virus load monitoring strategy, primary sclerosing cholangitis as an indication for LT, era (historic era linked to more intense long-term immunosuppression), and Epstein-Barr virus-seronegative recipient. No other independent risk factors were identified in this study. Of the 207 patients with primary sclerosing cholangitis as an indication for LT, 13 (6.3%) developed PTLD versus 16 out of 1074 (1.5%) patients with other underlying liver diseases (log-rank p <0.001). The yearly PTLD incidence was higher in the first year than in the later years after LT (2.4%/y vs. 0.6%/y) for primary sclerosing cholangitis, but not for other indications (0.16%/y). In Epstein-Barr virus-seronegative recipients PTLD occurred earlier after LT, while in 97% of seropositive recipients it could occur very late after LT.
移植后淋巴组织增生性疾病（PTLD）是肝移植（LT）后一种罕见但严重的并发症，具有发病率和死亡率。成人 PTLD 的危险因素尚未明确。本研究旨在评估成人 LT 后发生 PTLD 的危险因素。纳入了 1986 年至 2016 年间荷兰 2 个中心的所有成人 LT 受者，并进行了随访至 2020 年。PTLD 根据世界卫生组织（WHO）分类进行诊断。使用多变量 Cox 回归分析评估 PTLD 的潜在危险因素。共纳入 1281 例患者，其中 29 例（2.3%）发生了 PTLD。结果表明，成人 LT 后发生 PTLD 的独立危险因素包括无 EBV 载量监测策略、原发性硬化性胆管炎作为 LT 的适应证、时代（与更强烈的长期免疫抑制相关的历史时代）和 EBV 血清阴性受者。本研究未发现其他独立的危险因素。在以原发性硬化性胆管炎为 LT 适应证的 207 例患者中，13 例（6.3%）发生了 PTLD，而在其他 1074 例有其他潜在肝脏疾病的患者中，有 16 例（1.5%）发生了 PTLD（对数秩检验，p<0.001）。原发性硬化性胆管炎的 PTLD 年发生率在 LT 后第一年高于后几年（2.4%/年比 0.6%/年），而其他适应证则不然（0.16%/年）。在 EBV 血清阴性受者中，PTLD 在 LT 后较早发生，而在 97%的血清阳性受者中，PTLD 可能在 LT 后很晚发生。
