肾移植术后爱泼斯坦-巴尔病毒供受者血清学状态与预后的关联：一项回顾性队列研究
The Association of Epstein-Barr Virus Donor and Recipient Serostatus With Outcomes After Kidney Transplantation : A Retrospective Cohort Study.
作者信息
Potluri Vishnu S, Zhang Siqi, Schaubel Douglas E, Shaikhouni Salma, Blumberg Emily A, Nasta Sunita D, Bloom Roy D, Cruz-Peralta Massiel, Mehta Rajil B, Lavu Nikhil R, Getachew Bereket, Tandukar Srijan, Reese Peter P, Puttarajappa Chethan M
机构信息
Renal-Electrolyte and Hypertension Division, Hospital of the University of Pennsylvania, and Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania (V.S.P.).
Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania (S.Z., D.E.S.).
出版信息
Ann Intern Med. 2025 Feb;178(2):157-166. doi: 10.7326/ANNALS-24-00165. Epub 2025 Jan 28.
BACKGROUND
Prior studies indicate that 1% to 4% of Epstein-Barr virus (EBV)-seronegative recipients of EBV-seropositive donor (EBV D+/R-) kidneys develop posttransplant lymphoproliferative disorder (PTLD). However, these estimates are based on limited data that lack granularity.
OBJECTIVE
To determine the associations between pretransplant EBV D+/R- and recipient EBV-seropositive status (R+) and the outcomes of PTLD and graft and patient survival among adult kidney transplant recipients.
DESIGN
Retrospective cohort study.
SETTING
Two large U.S. transplant centers.
PARTICIPANTS
Epstein-Barr virus D+/R- and EBV R+ recipients matched 1:3 on donor, recipient, and transplant characteristics between 1 January 2010 and 30 June 2022.
MEASUREMENTS
Exposure was pretransplant donor and recipient EBV serostatus. The primary outcome was biopsy-proven PTLD. Secondary outcomes were all-cause graft loss (death, retransplant, or graft failure) and death. Follow-up was truncated to 3 years after transplant.
RESULTS
The final cohort comprised 104 EBV D+/R- recipients matched to 312 EBV R+ recipients. The mean age was 42 years (SD, 17.1), 59% were living donor transplants, and 95% received thymoglobulin induction. Among EBV D+/R- recipients, 50 (48.1%) developed EBV DNAemia, with a median time of 198 days (IQR, 110 to 282 days) after transplantation. Posttransplant lymphoproliferative disorder occurred in 23 (22.1%) EBV D+/R- recipients at a median of 202 days (IQR, 118 to 317 days) after transplantation. Epstein-Barr virus D+/R- recipients had higher all-cause graft failure (hazard ratio, 2.21 [95% CI, 1.06 to 4.63]); mortality was higher but not statistically significant (hazard ratio, 2.19 [CI, 0.94 to 5.13]).
LIMITATION
Two-center study.
CONCLUSION
Compared with previous studies, this study showed that EBV D+/R- kidney recipients face a 5- to 10-fold higher cumulative incidence of PTLD. Strategies to mitigate the PTLD risk are urgently needed.
PRIMARY FUNDING SOURCE
National Institutes of Health.
背景
先前的研究表明，1%至4%的接受EB病毒血清阳性供体肾脏（EBV D+/R-）的EB病毒血清阴性受者会发生移植后淋巴细胞增殖性疾病（PTLD）。然而，这些估计是基于缺乏详细数据的有限资料得出的。
目的
确定移植前EBV D+/R-和受者EB病毒血清阳性状态（R+）之间的关联，以及成年肾移植受者中PTLD的结局、移植物和患者生存率。
设计
回顾性队列研究。
地点
美国两个大型移植中心。
参与者
2010年1月1日至2022年6月30日期间，在供体、受者和移植特征方面按1:3匹配的EB病毒D+/R-和EBV R+受者。
测量指标
暴露因素为移植前供体和受者的EB病毒血清状态。主要结局是经活检证实的PTLD。次要结局是全因移植物丢失（死亡、再次移植或移植物衰竭）和死亡。随访在移植后3年截断。
结果
最终队列包括104名EBV D+/R-受者和312名与之匹配的EBV R+受者。平均年龄为42岁（标准差，17.1），59%为活体供体移植，95%接受了胸腺球蛋白诱导治疗。在EBV D+/R-受者中，50例（48.1%）出现EB病毒血症，移植后中位时间为198天（四分位间距，110至282天）。23例（22.1%）EBV D+/R-受者发生移植后淋巴细胞增殖性疾病，移植后中位时间为202天（四分位间距，118至317天）。EBV D+/R-受者的全因移植物衰竭发生率更高（风险比，2.21 [95%可信区间，1.06至4.63]）；死亡率更高，但无统计学意义（风险比，2.19 [可信区间，0.94至5.13]）。
局限性
两中心研究。
结论
与先前的研究相比，本研究表明EBV D+/R-肾移植受者发生PTLD的累积发生率高出5至10倍。迫切需要采取策略降低PTLD风险。
主要资金来源
美国国立卫生研究院。
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