Walker R C, Paya C V, Marshall W F, Strickler J G, Wiesner R H, Velosa J A, Habermann T M, Daly R C, McGregor C G
Division of Infectious Diseases, Mayo Clinic/Mayo Medical School, Rochester, MN 55905, USA.
J Heart Lung Transplant. 1995 Mar-Apr;14(2):214-21.
The relative importance and interrelationship of risk factors for posttransplantation lymphoproliferative disorder are poorly understood.
The prospective pretransplantation serologic testing for Epstein-Barr virus of all nonrenal solid organ transplant recipients at our institution made it possible to assess the relative risk for posttransplantation lymphoproliferative disorder in seropositive and seronegative recipients.
Fourteen cases of lymphoproliferative disorder were identified in the first 389 consecutive transplant recipients (288 liver, 44 heart, 20 lung, 37 kidney-pancreas) undergoing transplantation from 1985 to 1992 (mean follow-up 33 months). The incidence rates of lymphoproliferative disorder (per 100 person-years) during the first 2 years after transplantation (a period in which all cases occurred) were 1.4 for liver, 2.0 for heart, 6.2 for lung, and 5.2 for kidney-pancreas transplant recipients and were significantly different between liver and lung (p = 0.005) and liver and kidney-pancreas (p = 0.002) groups. Of 367 seropositive patients, lymphoproliferative disorder developed in only three. The incidence rate ratios between seronegative and seropositive recipients were as follows: 76 ([95% confidence interval; 46, 144], p = 0.0000) for any form of lymphoproliferative disorder and 145 ([60, 347], p = 0.0000) for fatal or brain forms. The incidence rate of lymphoproliferative disorder was significantly higher for seronegative recipients who required antilymphocyte antibody therapy for rejection than for those who received none.
The high intrinsic risk for lymphoproliferative disorder in the Epstein-Barr virus seronegative patient, which is amplified by higher levels of immunosuppression, may, in some instances, preclude transplantation.
移植后淋巴细胞增生性疾病的危险因素的相对重要性及相互关系尚未完全明确。
对我院所有非肾实体器官移植受者进行前瞻性移植前血清学检测，以评估血清阳性和血清阴性受者发生移植后淋巴细胞增生性疾病的相对风险。
在1985年至1992年间连续进行移植的389例受者（288例肝脏移植、44例心脏移植、20例肺移植、37例胰肾联合移植）中，共确诊14例淋巴细胞增生性疾病（平均随访33个月）。移植后前2年（所有病例均在此期间发生）淋巴细胞增生性疾病的发病率（每100人年）分别为：肝脏移植受者1.4、心脏移植受者2.0、肺移植受者6.2、胰肾联合移植受者5.2，肝脏与肺移植组（p = 0.005）以及肝脏与胰肾联合移植组（p = 0.002）之间存在显著差异。在367例血清阳性患者中，仅3例发生淋巴细胞增生性疾病。血清阴性与血清阳性受者的发病率比值如下：任何形式的淋巴细胞增生性疾病为76（[95%可信区间；46, 144]，p = 0.0000），致命性或脑部病变形式为145（[60, 347]，p = 0.0000）。因排斥反应需要抗淋巴细胞抗体治疗的血清阴性受者发生淋巴细胞增生性疾病的发病率显著高于未接受此类治疗的受者。
爱泼斯坦-巴尔病毒血清阴性患者发生淋巴细胞增生性疾病的内在风险较高，且免疫抑制水平越高风险越大，在某些情况下可能会妨碍移植。
