儿童心脏移植后的淋巴增殖障碍:一个多机构研究
Steven A Webber1, David C Naftel, F Jay Fricker
1Division of Cardiology, Department of Pediatrics, Children's Hospital and University of Pittsburgh, Pittsburgh, PA 15213, USA. steve.webber@chp.edu
Lancet (London, England)
|January 24, 2006
概括
移植后淋巴增殖性疾病 (PTLD) 影响5%的儿科心脏移植接受者,通常与爱斯坦-巴尔病毒有关. 管理需要改进治疗方法和策略,以保护移植心脏.
科学领域:
- 儿童心脏病学 儿童心脏病学
- 移植免疫学 移植免疫学
- 在瘤学瘤学.
背景情况:
- 移植后淋巴增殖性疾病 (PTLD) 是器官移植后并发症和死亡的重要原因.
- 了解儿科心脏移植患者的PTLD对于改善患者的治疗结果至关重要.
研究的目的:
- 确定心脏移植的儿童中PTLD的患病率,病理,治疗和结果.
- 在这个患者群体中确定生存和无事件生存的风险因素.
主要方法:
- 分析了1993年至2002年间的儿科心脏移植研究 (PHTS) 中1184名初级心脏移植接受者的数据.
- 评估包括没有PTLD的概率,疾病表现,病理,治疗和生存.
- 研究了生存和无事件生存的风险因素.
主要成果:
- 在1184名接受者中,56名 (5%) 患有PTLD,五年自由概率为92%.
- 胃肠道和呼吸系统是受影响最常见的部位. 大多数PTLD病例源自B细胞,并呈埃普斯坦-巴尔病毒阳性.
- 诊断后5年的生存概率为67%,移植损失与PTLD进展一样频繁的死亡原因.
结论:
- 大约5%的儿科心脏移植接受者发展PTLD,主要是B细胞类型和爱斯坦-巴尔病毒相关的.
- 虽然一些患者获得了良好的结果,但由于疾病进展和全移植损失,大量的死亡率仍然存在.
- 未来的管理应该优先考虑全移植保护和增强的PTLD疗法.
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