Montone K T, Litzky L A, Wurster A, Kaiser L, Bavaria J, Kotloff R, Palevsky H, Pietra G G, Tomaszewski J E
Department of Pathology and Laboratory Medicine, Hospital of The University of Pennsylvania, Philadelphia 19104, USA.
Surgery. 1996 May;119(5):544-51. doi: 10.1016/s0039-6060(96)80265-0.
Epstein-Barr virus (EBV)-associated posttransplantation lymphoproliferative disorder (PTLD) is a serious complication of lung transplantation. Besides immunosuppression the risk factors for PTLD development are largely unknown.
The incidence of PTLD was ascertained in a lung transplant population consisting of 45 patients. Nine patients (20%) experienced PTLD. The clinical, histologic, and human leukocyte antigen (HLA) data were collected on all patients. The incidence of EBV infection in lymphoid tissue taken at the time of engraftment was studied by using EBV in situ hybridization.
All patients with PTLD had polymorphous lymphoproliferations, seven of which were polymorphous B-cell hyperplasias and two of which were polymorphous B-cell lymphomas. EBV was identified in all lesions. All patients with polymorphous B-cell hyperplasias had clinically unsuspected disease, five of which were identified at autopsy. The two polymorphous B-cell lymphoma lesions were monoclonal and regressed with immunosuppression reduction. EBV in situ hybridization on donor or recipient lymph nodes obtained at engraftment from the 45 transplant recipients showed no difference in the number of EBV positive cells in patients with and without PTLD. Cyclosporine and PTLD and azathioprine dosages and cyclosporine levels were similar between patients with and without PTLD. PTLD was seen in patients with high cumulative doses of antilymphocyte globulin. Analysis of HLA status showed a predominance of HLA A2 and DR7 in the donors of the patients with PTLD, whereas donor HLA B7 was more common in patients without PTLD>
Detailed studies are necessary to further elucidate the risk factors for PTLD development in the lung transplant population.
爱泼斯坦-巴尔病毒（EBV）相关的移植后淋巴细胞增生性疾病（PTLD）是肺移植的一种严重并发症。除免疫抑制外，PTLD发生的危险因素大多未知。
在45例肺移植患者组成的群体中确定PTLD的发病率。9例患者（20%）发生了PTLD。收集了所有患者的临床、组织学和人类白细胞抗原（HLA）数据。通过EBV原位杂交研究移植时获取的淋巴组织中EBV感染的发生率。
所有PTLD患者均有多形性淋巴细胞增生，其中7例为多形性B细胞增生，2例为多形性B细胞淋巴瘤。所有病变中均检测到EBV。所有多形性B细胞增生患者临床上均未怀疑有疾病，其中5例在尸检时确诊。2例多形性B细胞淋巴瘤病变为单克隆性，随着免疫抑制的减轻而消退。对45例移植受者移植时获取的供体或受体淋巴结进行EBV原位杂交显示，发生PTLD和未发生PTLD的患者中EBV阳性细胞数量无差异。发生PTLD和未发生PTLD的患者之间环孢素、硫唑嘌呤剂量和环孢素水平相似。PTLD见于抗淋巴细胞球蛋白累积剂量高的患者。HLA状态分析显示，PTLD患者的供体中HLA A2和DR7占优势，而未发生PTLD的患者中供体HLA B7更常见。
有必要进行详细研究以进一步阐明肺移植人群中PTLD发生的危险因素。
