Aris R M, Maia D M, Neuringer I P, Gott K, Kiley S, Gertis K, Handy J
Division of Pulmonary and Critical Care Medicine, University of North Carolina at Chapel Hill 27599-7524, USA.
Am J Respir Crit Care Med. 1996 Dec;154(6 Pt 1):1712-7. doi: 10.1164/ajrccm.154.6.8970360.
Post-transplantation lymphoproliferative disorder (PTLD) is a widely recognized and often catastrophic complication of organ transplantation. The incidence of PTLD after lung transplantation ranges from 6.2 to 9.4% and is two-fold higher than that seen after organ transplantation of other organs. Primary Epstein-Barr virus (EBV) infection is a major risk factor for PTLD, but the incidence of PTLD in EBV seronegative (EBV-) patients seems to vary with type of organ transplant. The goal of this study was to quantify the risk of PLTD based on pre-lung transplantation EBV serostatus in lung transplant patients. Pre- and post-lung transplant serostatus was defined in 80 patients, and our six cases of PTLD occurred in this group. Six of 94 lung transplant patients (6.4%) who survived > 1 mo developed PTLD. All cases of PTLD involved thoracic structures at presentation and occurred in the first post-operative year. Patients who were EBV- before lung transplant were much more likely to develop PTLD than those who were seropositive (EBV+) (five of 15 [33%] versus one of 60 [< 2%], p < 0.001). Consistent with the prevailing adult (donor) EBV+ rate (85%), two of our EBV-patients remained EBV-after lung transplant. Therefore, the rate of PTLD was 42% in those with primary EBV infection. As compared with EBV-patients that remained tumor-free, those who developed PLTD had similar levels of immunosuppressants and doses of anti-viral therapy. We conclude that PLTD occurs predominantly in EBV-naïve patients (risk approximately 1/3). EBV-patients should be monitored more closely after lung transplantation and, possibly, managed with lower immunosuppression. Our data also suggest that anti-viral therapy alone does not decrease the incidence of PTLD in high risk patients, PTLD can be successfully treated in most cases, and EBV-naïve patients should not be excluded from lung transplant because their risk of death from PTLD is < 15%.
移植后淋巴细胞增生性疾病（PTLD）是器官移植中一种广为人知且往往具有灾难性的并发症。肺移植后PTLD的发生率在6.2%至9.4%之间，比其他器官移植后的发生率高出两倍。原发性爱泼斯坦 - 巴尔病毒（EBV）感染是PTLD的主要危险因素，但EBV血清阴性（EBV-）患者中PTLD的发生率似乎因器官移植类型而异。本研究的目的是根据肺移植患者肺移植前的EBV血清状态来量化PTLD的风险。对80例患者进行了肺移植前后的血清状态定义，本研究组中有6例发生了PTLD。94例存活超过1个月的肺移植患者中有6例（6.4%）发生了PTLD。所有PTLD病例在发病时均累及胸部结构，且均发生在术后第一年。肺移植前为EBV-的患者比血清阳性（EBV+）的患者更易发生PTLD（15例中有5例[33%]，而60例中有1例[<2%]，p<0.001）。与成人（供体）普遍的EBV+率（85%）一致，我们的2例EBV-患者肺移植后仍为EBV-。因此，原发性EBV感染患者中PTLD的发生率为42%。与未发生肿瘤的EBV-患者相比，发生PTLD的患者免疫抑制剂水平和抗病毒治疗剂量相似。我们得出结论，PTLD主要发生在未感染EBV的患者中（风险约为1/3）。肺移植后应对EBV-患者进行更密切的监测，并可能采用较低的免疫抑制治疗。我们的数据还表明，单独的抗病毒治疗并不能降低高危患者PTLD的发生率，大多数情况下PTLD可得到成功治疗，且不应因未感染EBV的患者发生PTLD的死亡风险<15%而将其排除在肺移植之外。
