Department of Surgery, Division of Transplantation, University of Minnesota, Minneapolis, Minnesota, USA.
Department of Medicine, Division of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis, Minnesota, USA.
Clin Transplant. 2024 Aug;38(8):e15386. doi: 10.1111/ctr.15386.
Chronic immunosuppression following pancreas transplantation carries significant risk, including posttransplant lymphoproliferative disease (PTLD). We sought to define the incidence, risk factors, and long-term outcomes of PTLD following pancreas transplantation at a single center.
All adult pancreas transplants between February 1, 1983 and December 31, 2023 at the University of Minnesota were reviewed, including pancreas transplant alone (PTA), simultaneous pancreas-kidney transplants (SPK), and pancreas after kidney transplants (PAK).
Among 2353 transplants, 110 cases of PTLD were identified, with an overall incidence of 4.8%. 17.3% were diagnosed within 1 year of transplant, 32.7% were diagnosed within 5 years, and 74 (67.3%) were diagnosed after 5 years. The overall 30-year incidence of PTLD did not differ by transplant type-7.4% for PTA, 14.2% for SPK, and 19.4% for PAK (p = 0.3). In multivariable analyses, older age and Epstein-Barr virus seronegativity were risk factors for PTLD, and PTLD was a risk factor for patient death. PTLD-specific mortality was 32.7%, although recipients with PTLD had similar median posttransplant survival compared to those without PTLD (14.9 year vs. 15.6 year, p = 0.9).
PTLD following pancreas transplantation is associated with significant mortality. Although the incidence of PTLD has decreased over time, a high index of suspicion for PTLD following PTx should remain in EBV-negative recipients.
胰腺移植后慢性免疫抑制会带来重大风险，包括移植后淋巴组织增生性疾病（PTLD）。我们旨在确定单中心胰腺移植后 PTLD 的发病率、风险因素和长期结果。
回顾了 1983 年 2 月 1 日至 2023 年 12 月 31 日期间在明尼苏达大学进行的所有成人胰腺移植，包括单纯胰腺移植（PTA）、胰腺-肾联合移植（SPK）和肾移植后胰腺移植（PAK）。
在 2353 例移植中，发现 110 例 PTLD，总发病率为 4.8%。17.3%在移植后 1 年内诊断，32.7%在 5 年内诊断，74 例（67.3%）在 5 年后诊断。PTLD 的 30 年总体发生率与移植类型无关-PTA 为 7.4%，SPK 为 14.2%，PAK 为 19.4%（p=0.3）。多变量分析中，年龄较大和 EBV 血清阴性是 PTLD 的危险因素，而 PTLD 是患者死亡的危险因素。PTLD 特异性死亡率为 32.7%，尽管患有 PTLD 的受者与没有 PTLD 的受者的中位移植后生存时间相似（14.9 年比 15.6 年，p=0.9）。
胰腺移植后 PTLD 与显著的死亡率相关。尽管 PTLD 的发病率随着时间的推移而降低，但在 EBV 阴性受者中，对 PTx 后 PTLD 的高度怀疑仍应保持。
