RESUMO
BACKGROUND: Post-transplantation lymphoproliferative disorder (PTLD) after liver transplantation is a rare but potentially fatal disease. Clinical manifestations and prevalence of PTLD after liver transplantation in Korea have not been investigated thoroughly. MATERIALS AND METHODS: A retrospective chart review was done for 284 liver transplant recipients at Samsung Medical Center, Seoul, Korea during the period from 1996 to 2003. RESULTS: The incidence of PTLD after liver transplantation was 3.9% (11/284). PTLDs were more prevalent in children (9/55, 16.4%) than in adults (2/237, 0.9%; P<0.01). Among the PTLD patients, four cases were male (36.3%) and seven were female (63.7%). Median time from the transplantation to PTLD diagnosis was 9 months. The type of PTLD was as follows:early lesion (6 cases, 54.5%), polymorphic PTLD (3 cases, 27.3%), and B cell lymphoma (2 cases, 18.2%). PTLDs were more prevalent in the patients with cyclosporine use (OR 13.28, 95% CI:1.29-136.31, P=0.03), acute rejection (OR 5.63, 95% CI:1.03-30.62, P=0.04), and negative serology for EBV VCA IgG (OR 19.15, 95% CI:1.99-183.98, P=0.01) by multivariate logistic regression. Three patients (27.3%) died of B cell lymphoma (2 cases) and polymorphic PTLD (1 case). The remaining patients were improved with reduction of immunosuppression and treatment with acyclovir. CONCLUSION: The incidence of PTLD was high in children. The risk factors of PTLD were negative serology for EBV VCA IgG, history of acute rejection, and cyclosporine use. Considering the poor prognosis of PTLD, effective strategies for prevention and early diagnosis for early treatment should be emphasized.
Assuntos
Adulto , Criança , Feminino , Humanos , Masculino , Aciclovir , Ciclosporina , Diagnóstico , Diagnóstico Precoce , Herpesvirus Humano 4 , Imunoglobulina G , Terapia de Imunossupressão , Incidência , Coreia (Geográfico) , Transplante de Fígado , Fígado , Modelos Logísticos , Linfoma de Células B , Transtornos Linfoproliferativos , Prevalência , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Seul , TransplanteRESUMO
BACKGROUND: Post-transplantation lymphoproliferative disorder (PTLD) after liver transplantation is a rare but potentially fatal disease. Clinical manifestations and prevalence of PTLD after liver transplantation in Korea have not been investigated thoroughly. MATERIALS AND METHODS: A retrospective chart review was done for 284 liver transplant recipients at Samsung Medical Center, Seoul, Korea during the period from 1996 to 2003. RESULTS: The incidence of PTLD after liver transplantation was 3.9% (11/284). PTLDs were more prevalent in children (9/55, 16.4%) than in adults (2/237, 0.9%; P<0.01). Among the PTLD patients, four cases were male (36.3%) and seven were female (63.7%). Median time from the transplantation to PTLD diagnosis was 9 months. The type of PTLD was as follows:early lesion (6 cases, 54.5%), polymorphic PTLD (3 cases, 27.3%), and B cell lymphoma (2 cases, 18.2%). PTLDs were more prevalent in the patients with cyclosporine use (OR 13.28, 95% CI:1.29-136.31, P=0.03), acute rejection (OR 5.63, 95% CI:1.03-30.62, P=0.04), and negative serology for EBV VCA IgG (OR 19.15, 95% CI:1.99-183.98, P=0.01) by multivariate logistic regression. Three patients (27.3%) died of B cell lymphoma (2 cases) and polymorphic PTLD (1 case). The remaining patients were improved with reduction of immunosuppression and treatment with acyclovir. CONCLUSION: The incidence of PTLD was high in children. The risk factors of PTLD were negative serology for EBV VCA IgG, history of acute rejection, and cyclosporine use. Considering the poor prognosis of PTLD, effective strategies for prevention and early diagnosis for early treatment should be emphasized.
Assuntos
Adulto , Criança , Feminino , Humanos , Masculino , Aciclovir , Ciclosporina , Diagnóstico , Diagnóstico Precoce , Herpesvirus Humano 4 , Imunoglobulina G , Terapia de Imunossupressão , Incidência , Coreia (Geográfico) , Transplante de Fígado , Fígado , Modelos Logísticos , Linfoma de Células B , Transtornos Linfoproliferativos , Prevalência , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Seul , TransplanteRESUMO
OBJECTIVE:To evaluate the clinical usefulness of cytomegalovirus (CMV) antigenemia assay among liver transplant recipients in Samsung Medical Center. MATERIALS AND METHODS: All recipients of liver transplantation during the period from Jan. 1996 to Aug. 2003 were enrolled. Medical records and microbiologic data for CMV infections were reviewed retrospectively. RESULTS: All 284 enrolled patients received livers from CMV seropositive donors, and 272 recipients (95.8%) were CMV seropositive before transplantation. One hundred thirty three recipients (46.8%) had evidences of CMV reactivation. Among patients with CMV reactivation, 40 recipients were symptomatic (30.1%) and 12 patients had organ-specific CMV diseases. Most of the CMV infections occurred within 180 days after transplantation except for 9 patients (6.7%). Among the antigenemia positive patients, the mean number of CMV antigen-positive WBC was 19.36 per 200,000 cells (19.36+/-37.64 cells). The mean duration of CMV antigenemia was 8.72 days (8.72+/-9.99 days). Peak value of CMV antigenemia was significantly higher in symptomatic patients compared to asymptomatic patients (P=0.002). Duration of CMV antigenemia was significantly longer (P=0.002) in symptomatic patients. If we would use > or = 5 cells of CMV antigenemia as a cut-off value sensitivity and specificity for symptomatic CMV infections would be 85% and 50% respectively. CONCLUSION: About half of the recipients experienced CMV reactivation, mostly within 180 days after liver transplantation. Thirty percents of reactivation were symptomatic. Five cells per 200,000 leukocytes of CMV antigenemia was the best cut-off level for preemptive treatment.
Assuntos
Humanos , Citomegalovirus , Leucócitos , Transplante de Fígado , Fígado , Prontuários Médicos , Estudos Retrospectivos , Sensibilidade e Especificidade , Doadores de Tecidos , TransplanteRESUMO
OBJECTIVE:To evaluate the clinical usefulness of cytomegalovirus (CMV) antigenemia assay among liver transplant recipients in Samsung Medical Center. MATERIALS AND METHODS: All recipients of liver transplantation during the period from Jan. 1996 to Aug. 2003 were enrolled. Medical records and microbiologic data for CMV infections were reviewed retrospectively. RESULTS: All 284 enrolled patients received livers from CMV seropositive donors, and 272 recipients (95.8%) were CMV seropositive before transplantation. One hundred thirty three recipients (46.8%) had evidences of CMV reactivation. Among patients with CMV reactivation, 40 recipients were symptomatic (30.1%) and 12 patients had organ-specific CMV diseases. Most of the CMV infections occurred within 180 days after transplantation except for 9 patients (6.7%). Among the antigenemia positive patients, the mean number of CMV antigen-positive WBC was 19.36 per 200,000 cells (19.36+/-37.64 cells). The mean duration of CMV antigenemia was 8.72 days (8.72+/-9.99 days). Peak value of CMV antigenemia was significantly higher in symptomatic patients compared to asymptomatic patients (P=0.002). Duration of CMV antigenemia was significantly longer (P=0.002) in symptomatic patients. If we would use > or = 5 cells of CMV antigenemia as a cut-off value sensitivity and specificity for symptomatic CMV infections would be 85% and 50% respectively. CONCLUSION: About half of the recipients experienced CMV reactivation, mostly within 180 days after liver transplantation. Thirty percents of reactivation were symptomatic. Five cells per 200,000 leukocytes of CMV antigenemia was the best cut-off level for preemptive treatment.