Cox K L, Lawrence-Miyasaki L S, Garcia-Kennedy R, Lennette E T, Martinez O M, Krams S M, Berquist W E, So S K, Esquivel C O
Department of Transplantation, California Pacific Medical Center, San Francisco 94115.
Transplantation. 1995 Feb 27;59(4):524-9.
The incidence of Epstein-Barr virus (EBV) infection and lymphoproliferative disorder (LPD) was determined in a pediatric liver transplant population consisting of 51 children treated with FK506 and 91 treated with cyclosporine. The incidence of symptomatic EBV infection was 21.9% (23 of 105 cases) in children < 5 yr old and 10.8% (4 of 37 cases) in children 5 to 17 yr old as compared with 2.7% (9 of 323 cases) in adults (P < 0.0001). In the under 5 yr old group on cyclosporine, the incidences of EBV infection and LPD were 9 of 68 (13.2%) and 2 of 68 children, (2.9%), respectively. In contrast, in children under 5 yr old group on FK506, the incidences of EBV infection and LPD in the FK506 group were 14 of 37 (37.8%) and 7 of 37 children (18.9%), respectively. The difference between these two groups was statistically significant (P < 0.02). There were no cases of LPD in the 5-17 yr-old children on either cyclosporine (n = 23) or FK506 (n = 14). The incidence of EBV infections in the 5 to 17 yr age group, 17.4% on cyclosporine and 0% on FK506, was less than for the younger children on FK506 (37.8%). A total of 39% (9 of 23) of children under 5 yr old who had symptomatic EBV infections developed LPD, and 44% (4 of 9) with LPD died. The higher incidence of EBV infections and LPD in the younger children treated with FK506 was probably related to a greater intensity of immunosuppression for patients on FK506 than those on cyclosporine.
在一个儿科肝移植人群中确定了爱泼斯坦-巴尔病毒（EBV）感染和淋巴增殖性疾病（LPD）的发生率，该人群包括51名接受FK506治疗的儿童和91名接受环孢素治疗的儿童。<5岁儿童中症状性EBV感染的发生率为21.9%（105例中的23例），5至17岁儿童中为10.8%（37例中的4例），而成人中为2.7%（323例中的9例）（P<0.0001）。在5岁以下接受环孢素治疗的儿童组中，EBV感染和LPD的发生率分别为68例中的9例（13.2%）和68例儿童中的2例（2.9%）。相比之下，在5岁以下接受FK506治疗的儿童组中，FK506组中EBV感染和LPD的发生率分别为37例中的14例（37.8%）和37例儿童中的7例（18.9%）。这两组之间的差异具有统计学意义（P<0.02）。在5至17岁接受环孢素（n=23）或FK506（n=14）治疗的儿童中均无LPD病例。5至17岁年龄组中EBV感染的发生率，环孢素治疗时为17.4%，FK506治疗时为0%，低于接受FK506治疗的年幼儿童（37.8%）。共有39%（23例中的9例）有症状性EBV感染的5岁以下儿童发生了LPD，且LPD患者中有44%（9例中的4例）死亡。接受FK506治疗的年幼儿童中EBV感染和LPD的较高发生率可能与FK506治疗患者的免疫抑制强度大于环孢素治疗患者有关。
