Armes J E, Angus P, Southey M C, Battaglia S E, Ross B C, Jones R M, Venter D J
Department of Anatomical Pathology, Austin Hospital, Heidelberg, Victoria, Australia.
Cancer. 1994 Nov 1;74(9):2436-41. doi: 10.1002/1097-0142(19941101)74:9<2436::aid-cncr2820740908>3.0.co;2-s.
Lymphoproliferative disease is a well recognized complication of organ transplantation and in many cases is associated with Epstein-Barr virus (EBV) infection. It is widely though that posttransplantation lymphoproliferative disease (PTLPD) arises from recipient lymphoid cells. However, solid organ allografts are likely to include donor lymphoid tissue around or within the transplanted organ. Therefore, it is possible that transplanted donor lymphocytes may proliferate to form PTLPD:
The genetic origin of tumor cells was determined by microsatellite DNA fingerprinting using the polymerase chain reaction (PCR). Their EBV association and clonality were established by PCR amplification of DNA extracted from formalin fixed, paraffin embedded tissue using primers to conserved regions of the EBV genome and the immunoglobulin heavy chain gene, respectively.
The authors have demonstrated two cases of lymphoproliferative disease that were derived from donor lymphocytes in orthotopic liver transplant recipients. In both cases, the proliferating cells were EBV DNA positive. Furthermore, the PTLPD was restricted to allograft tissue around the porta hepatis. However, the two cases differed in their clonal properties and response to treatment: one case was oligoclonal and regressed after antiviral therapy and a modest reduction of immunosuppression, whereas the other contained two clonal populations and was controlled only after treatment with antineoplastic chemotherapy.
This study has demonstrated two cases of PTLPD that were derived from donor lymphoid tissue. Although both cases were associated with EBV and remained localized to allograft tissue, their clonality and response to therapy differed.
淋巴增殖性疾病是器官移植中一种公认的并发症，在许多情况下与爱泼斯坦-巴尔病毒（EBV）感染相关。人们普遍认为移植后淋巴增殖性疾病（PTLPD）源于受体淋巴细胞。然而，实体器官同种异体移植物很可能包含移植器官周围或内部的供体淋巴组织。因此，移植的供体淋巴细胞有可能增殖形成PTLPD。
使用聚合酶链反应（PCR）通过微卫星DNA指纹图谱确定肿瘤细胞的遗传起源。通过分别使用针对EBV基因组保守区域和免疫球蛋白重链基因的引物，对从福尔马林固定、石蜡包埋组织中提取的DNA进行PCR扩增，确定其与EBV的关联及克隆性。
作者展示了两例原位肝移植受者中源自供体淋巴细胞的淋巴增殖性疾病病例。在这两例中，增殖细胞的EBV DNA均为阳性。此外，PTLPD局限于肝门周围的同种异体移植组织。然而，这两例在克隆特性和对治疗的反应方面存在差异：一例为寡克隆性，在抗病毒治疗及适度降低免疫抑制后病情缓解，而另一例包含两个克隆群体，仅在接受抗肿瘤化疗后病情得到控制。
本研究展示了两例源自供体淋巴组织的PTLPD病例。尽管两例均与EBV相关且局限于同种异体移植组织，但它们的克隆性及对治疗的反应有所不同。
