Posttransplant Lymphoproliferative Disease Following Pancreas Transplantation: A 40 Year Single-Center Experience

IF 1.9 4区医学 Q2 SURGERY

Clinical Transplantation Pub Date : 2024-08-01 DOI:10.1111/ctr.15386

Abraham J. Matar, Erik B. Finger, Joseph Maakaron, Emmanuel Minja, Karthik Ramanathan, Vanessa Humphreville, Joseph S. Rao, Jessica Fisher, David E. R. Sutherland, Arthur J. Matas, Raja Kandaswamy

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Abstract

Background

Chronic immunosuppression following pancreas transplantation carries significant risk, including posttransplant lymphoproliferative disease (PTLD). We sought to define the incidence, risk factors, and long-term outcomes of PTLD following pancreas transplantation at a single center.

Methods

All adult pancreas transplants between February 1, 1983 and December 31, 2023 at the University of Minnesota were reviewed, including pancreas transplant alone (PTA), simultaneous pancreas–kidney transplants (SPK), and pancreas after kidney transplants (PAK).

Results

Among 2353 transplants, 110 cases of PTLD were identified, with an overall incidence of 4.8%. 17.3% were diagnosed within 1 year of transplant, 32.7% were diagnosed within 5 years, and 74 (67.3%) were diagnosed after 5 years. The overall 30-year incidence of PTLD did not differ by transplant type—7.4% for PTA, 14.2% for SPK, and 19.4% for PAK (p = 0.3). In multivariable analyses, older age and Epstein-Barr virus seronegativity were risk factors for PTLD, and PTLD was a risk factor for patient death. PTLD-specific mortality was 32.7%, although recipients with PTLD had similar median posttransplant survival compared to those without PTLD (14.9 year vs. 15.6 year, p = 0.9).

Conclusions

PTLD following pancreas transplantation is associated with significant mortality. Although the incidence of PTLD has decreased over time, a high index of suspicion for PTLD following PTx should remain in EBV-negative recipients.

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胰腺移植后淋巴组织增生症：40 年的单中心经验

背景：胰腺移植后的慢性免疫抑制具有重大风险，包括移植后淋巴组织增生性疾病（PTLD）。我们试图在一个中心确定胰腺移植后淋巴组织增生性疾病的发病率、风险因素和长期结果：方法：回顾明尼苏达大学1983年2月1日至2023年12月31日期间的所有成人胰腺移植手术，包括单纯胰腺移植（PTA）、胰肾同步移植（SPK）和肾移植后胰腺移植（PAK）：结果：在 2353 例移植中，发现了 110 例 PTLD，总发病率为 4.8%。17.3%在移植后 1 年内确诊，32.7%在 5 年内确诊，74 例（67.3%）在 5 年后确诊。PTLD的30年总发病率因移植类型而异，PTA为7.4%，SPK为14.2%，PAK为19.4%（P = 0.3）。在多变量分析中，年龄较大和Epstein-Barr病毒血清阴性是PTLD的风险因素，而PTLD是患者死亡的风险因素。PTLD特异性死亡率为32.7%，但与无PTLD的受者相比，有PTLD的受者移植后中位生存期相似（14.9年对15.6年，P = 0.9）：结论：胰腺移植后的PTLD与严重的死亡率有关。尽管随着时间的推移，PTLD 的发病率有所下降，但对于 EBV 阴性的受者，仍应高度怀疑 PTLD 的存在。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Transplantation 医学-外科

CiteScore

3.70

自引率

4.80%

发文量

286

审稿时长

2 months

期刊介绍： Clinical Transplantation: The Journal of Clinical and Translational Research aims to serve as a channel of rapid communication for all those involved in the care of patients who require, or have had, organ or tissue transplants, including: kidney, intestine, liver, pancreas, islets, heart, heart valves, lung, bone marrow, cornea, skin, bone, and cartilage, viable or stored. Published monthly, Clinical Transplantation’s scope is focused on the complete spectrum of present transplant therapies, as well as also those that are experimental or may become possible in future. Topics include: Immunology and immunosuppression; Patient preparation; Social, ethical, and psychological issues; Complications, short- and long-term results; Artificial organs; Donation and preservation of organ and tissue; Translational studies; Advances in tissue typing; Updates on transplant pathology;. Clinical and translational studies are particularly welcome, as well as focused reviews. Full-length papers and short communications are invited. Clinical reviews are encouraged, as well as seminal papers in basic science which might lead to immediate clinical application. Prominence is regularly given to the results of cooperative surveys conducted by the organ and tissue transplant registries. Clinical Transplantation: The Journal of Clinical and Translational Research is essential reading for clinicians and researchers in the diverse field of transplantation: surgeons; clinical immunologists; cryobiologists; hematologists; gastroenterologists; hepatologists; pulmonologists; nephrologists; cardiologists; and endocrinologists. It will also be of interest to sociologists, psychologists, research workers, and to all health professionals whose combined efforts will improve the prognosis of transplant recipients.