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논문KCI 등재

간이식 후 발생한 림프구 증식성 질환의 임상적 양상

Clinical Manifestations of Posttransplantation Lymphoproliferative Disorder (PTLD) after Liver Transplantation

김성주|이지영|이석구|송재훈|조재원|고영혜|문치숙|백경란|위유미|손경목|오원섭|기현균
대한감염학회 (The Korean Society Of Infectious Diseases)|2006.06|Infection and Chemotherapy|제38권 제3호|pp. 131-139

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초록

목 적 : 이식 후 발생하는 림프구 증식질환 (Post- transplantation lymphoproliferative disorder, PTLD)은 환자에게 치명적일 수 있는 합병증이지만 국내에서 간이식 후 PTLD 보고례가 많지 않아 이에 대한 임상적인 양상을 분석하였다.재료 및 방법 : 삼성서울병원 이식외과에서 1996년부터 2003년까지 간이식을 시행받은 총 284명의 환자들을 대상으로 후향적 연구를 진행하였다.결 과 : 총 284명의 간이식례 중 PTLD가 발생한 경우는 11례로 3.9%의 발생률을 보였다. 성인의 발생률은 0.9%, 소아의 발생률은 16.4%로 소아에서 발생률이 높았다. 남자가 4명, 여자가 7명이었고 이식 후 PTLD 발생까지의 중앙값은 9개월이었다. PTLD의 유형으로는 초기 병변이 6례, polymorphic PTLD가 3례, B cell lymphoma가 2례였으며 B cell lymphoma 환자 2명과 polymorphic PTLD 환자 1명은 사망하였다. PTLD의 발생과 관련된 요인으로는 cyclosporine 사용(OR 13.28, 95% CI : 1.29- 136.31, P=0.03), 급성 거부반응(OR 5.63, 95% CI : 1.03- 30.62, P=0.04), EBV-VCA IgG 음성인 환자(OR 19.15, 95% CI : 1.99-183.98, P=0.01)에서 발생빈도가 높았다.

Abstract

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.

참고문헌 (41)

  1. "Posttransplantation lymphoproliferative disorders", 163, pp.1997~2004 (2003)
  2. "Identifying the patient at risk for post-transplant lymphoproliferative disorder", 3, pp.70~78 (2001)
  3. "Epstein-Barr virus infection", 343, pp.481~492 (2000)
  4. "Malignancy in renal transplant recipients", 13, pp.133~140 (1999)
  5. "Epstein Barr virus associated angiocentric T cell lymphoma in nasal cavity of renal transplantation recipient", 42, pp.1041~1045 (1999)
  6. "Posttransplant lymphoproliferative disease (PTLD) following renal transplantation J Korean Soc Transplant", pp.337~345 (1997)
  7. "De novo malignancy in kidney transplantation recipient", 14, pp.41~46 (2000)
  8. "Four cases of posttransplant lymphoproliferative diseases(PTLD)following renal transplantation", 14, pp.101~108 (2000)
  9. "A case of posttransplant lymphoproliferative disease following renal transplantation in a child", 6, pp.123~130 (2002)
  10. "Mucosa-associated lymphoid tissue lymphoma following kidney transplantation", 37, pp.231~235 (2002)
  11. "A case of posttransplant lymphoproliferative disease following renal transplantation in a child", 7, pp.245~252 (2003)
  12. "NK", T-cell lymphoma involving multiple organs in renal transplant recipient, 2004, pp.23, 358~363
  13. "A case of posttransplantation lymphoproliferative disease developed in renal transplant recipient and treated with rituximab", 67, pp.94~99 (2004)
  14. "Two cases of posttransplantation lymphoproliferative disorders in recipients of liver transplantation", 56, pp.399~402 (1999)
  15. "An incidence of childhood Epstein-Barr virus infection and lymphoproliferative disease after liver transplantation", 13, pp.141~148 (1999)
  16. "Posttransplant lymphoproliferative disorder - A report of 4 cases -", 36, pp.45~50 (2002)
  17. "Posttransplantation lymphoproliferatvie disorder in pediatric liver transplantation:Samsung Medical Center experience", 6, pp.39~46 (2003)
  18. "Infectious complications after liver transplantation according to donor:Comparison between orthotopic and living donor transplantation", 36, pp.139~147 (2004)
  19. "Epstein-Barr virus associated B cell lymphoproliferative disorders following bone marrow transplantation", 71, pp.1234~43 (1988)
  20. "The frequency of Epstein-Barr virus infection and associated lymphoproliferative syndrome after transplantation and its manifestations in children", 45, pp.719~27 (1988)
  21. "Epstein-Barr virus infections and DNA hybridization studies in posttransplantation lymphoma and lymphoproliferative lesions:the role of primary infection", 152, pp.876~86 (1985)
  22. "Epstein-Barr virus- associated lymphoproliferative disease in a heart- lung allograft.Demonstration of host origin by restriction fragment-length polymorphism analysis", 49, pp.126~30 (1990)
  23. "Transmission of donor Epstein-Barr virus(EBV)in transplanted organs causes lymphoproliferative disease in EBV-seronegative recipients", 77, pp.1169~1172 (1996)
  24. "Posttransplant lymphoproliferative disease in primary Epstein-Barr virus infection after liver transplantation:the role of cytomegalovirus disease", 176, pp.1462~1467 (1997)
  25. "Pretransplantation assessment of the risk of lymphoproliferative disorder", 20, pp.1346~1353 (1995)
  26. "Incidence of non-Hodgkin lymphoma in kidney and heart transplant recipients", 342, pp.1514~6 (1993)
  27. "Cytomegalovirus infection and posttransplant lymphoproliferative disease in renal transplant recipients : results of the U.S.", 68, pp.1203~1205 (1999)
  28. "North American Pediatric Renal Transplant Cooperative Study (NAPRTCS) Risk factors for posttransplant lymphoproliferative disorder (PTLD) in pediatric kidney transplantation : a report of the North American Pediatric Renal Transplant Cooperative Study (NAPRTCS)", 71, pp.1065~1068 (2001)
  29. "An increased incidence of Epstein-Barr virus infection and lymphoproliferative disorder in young children on FK506 after liver transplantation", 59, pp.524~529 (1995)
  30. "Posttransplant lymphoproliferative disorders after renal transplantation in the United States in era of modern immunosuppression", 80, pp.1233~1243 (2005)
  31. "Posttransplant lymphoproliferative disorder among renal transplant patients in relation to the use of mycophenolate mofetil", 80, pp.1174~1180 (2005)
  32. "Role of hepatitis C virus in lymphoproliferative disorders after liver transplantation", 30, pp.775~778 (1999)
  33. "Risk factors for lymphoproliferative disorders after liver transplantation in adults : an analysis of 480 patients", 74, pp.1103~1109 (2002)
  34. "Posttransplant lymphoproliferative disorders in adult and pediatric renal transplant patients receiving tacrolimus-based immunosuppression", 68, pp.1851~1854 (1999)
  35. "Post-transplant lymphoproliferative disorders.", pp.264~269 (2001), IARC Press
  36. "Posttransplant lymphoproliferative disorders in liver transplantation: a 20-year experience.", 236, pp.429~437 (2002)
  37. "Influence of host-recipient origin on clinical aspects of posttransplantation lymphoproliferative disorders in kidney transplantation", 73, pp.265~271 (2002)
  38. "Reduced incidence of Epstein-Barr virus-associated posttransplant lymphoproliferative disorder using preemptive antiviral therapy", 64, pp.848~852 (1997)
  39. "Antiviral prophylaxis and the Epstein Barr virus-related post-transplant lymphoproliferative disorder", 9, pp.53~59 (1995)
  40. "Diagnosis and management of posttransplant lymphoproliferative disorder in solid-organ transplant recipients", 33, pp.38~46 (2001)
  41. "Complete immunosuppresive withdrawal as a uniform approach to post- ransplant lymphoproliferative disease in pediatric liver transplantation", 8, pp.267~272 (2004)

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