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タイトル: Post‐transplant Lymphoproliferative Disorders After Liver Transplantation: A Retrospective Cohort Study Including 1954 Transplants
著者: Tajima, Tetsuya
Hata, Koichiro  kyouindb  KAKEN_id  orcid https://orcid.org/0000-0002-3609-6396 (unconfirmed)
Haga, Hironori  kyouindb  KAKEN_id
Nishikori, Momoko  kyouindb  KAKEN_id  orcid https://orcid.org/0000-0003-4171-2162 (unconfirmed)
Umeda, Katsutsugu  kyouindb  KAKEN_id
Kusakabe, Jiro
Miyauchi, Hidetaka  kyouindb  KAKEN_id  orcid https://orcid.org/0000-0003-0961-7130 (unconfirmed)
Okamoto, Tatsuya
Ogawa, Eri
Sonoda, Mari
Hiramatsu, Hidefumi  kyouindb  KAKEN_id  orcid https://orcid.org/0000-0003-3136-5670 (unconfirmed)
Fujimoto, Masakazu  kyouindb  KAKEN_id  orcid https://orcid.org/0000-0002-0575-6507 (unconfirmed)
Okajima, Hideaki
Takita, Junko  kyouindb  KAKEN_id  orcid https://orcid.org/0000-0002-2452-6520 (unconfirmed)
Takaori-Kondo, Akifumi
Uemoto, Shinji
著者名の別形: 田嶋, 哲也
秦, 浩一郎
羽賀, 博典
錦織, 桃子
梅田, 雄嗣
日下部, 治郎
宮内, 英孝
岡本, 竜弥
小川, 絵里
園田, 真理
平松, 英文
藤本, 正数
岡島, 英明
滝田, 順子
髙折, 晃史
上本, 伸二
発行日: Aug-2021
出版者: Wiley
American Association for the Study of Liver Diseases
誌名: Liver Transplantation
巻: 27
号: 8
開始ページ: 1165
終了ページ: 1180
抄録: Post-transplant lymphoproliferative disorders (PTLDs) are life-threatening neoplasms after organ transplantation. Because of their rarity and multiple grades of malignancy, the incidence, outcomes, and clinicopathological features affecting patient survival after liver transplantation (LT) remain unclear. We reviewed 1954 LTs in 1849 recipients (1990-2020), including 886 pediatric (<18 years of age) and 963 adult recipients. The following clinicopathological factors were studied: age, sex, liver etiologies, malignancy grades, Epstein-Barr virus status, performance status (PS), Ann Arbor stage, international prognostic index, and histopathological diagnosis. Of 1849 recipients, 79 PTLD lesions (4.3%) were identified in 70 patients (3.8%). After excluding 3 autopsy cases incidentally found, 67 (45 pediatric [5.1%] and 22 adult [2.3%]) patients were finally enrolled. Comorbid PTLDs significantly worsened recipient survival compared with non-complicated cases (P < 0.001). The 3-year, 5-year, and 10-year overall survival rates after PTLD diagnosis were 74%, 66%, and 58%, respectively. The incidence of PTLDs after LT (LT-PTLDs) was significantly higher (P < 0.001) with earlier onset (P = 0.002) in children, whereas patient survival was significantly worse in adults (P = 0.002). Univariate and multivariate analyses identified the following 3 prognostic factors: age at PTLD diagnosis ≥18 years (hazard ratio [HR], 11.2; 95% confidence interval [CI], 2.63-47.4; P = 0.001), PS ≥2 at diagnosis (HR, 6.77; 95% CI, 1.56-29.3; P = 0.01), and monomorphic type (HR, 6.78; 95% CI, 1.40-32.9; P = 0.02). A prognostic index, the “LT-PTLD score, ” that consists of these 3 factors effectively stratified patient survival and progression-free survival (P = 0.003 and <0.001, respectively). In conclusion, comorbid PTLDs significantly worsened patient survival after LT. Age ≥18 years and PS ≥2 at PTLD diagnosis, and monomorphic type are independent prognostic factors, and the LT-PTLD score that consists of these 3 factors may distinguish high-risk cases and guide adequate interventions.
著作権等: Copyright © 2021 The Authors. Liver Transplantation published by Wiley Periodicals LLC on behalf of American Association for the Study of Liver Diseases.
This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.
URI: http://hdl.handle.net/2433/277487
DOI(出版社版): 10.1002/lt.26034
PubMed ID: 33655645
出現コレクション:学術雑誌掲載論文等

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