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.
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.
摘要：
背景：胰腺移植后的慢性免疫抑制具有显著的风险，包括移植后淋巴增生性疾病（PTLD）。我们试图定义发病率，危险因素，单中心胰腺移植后PTLD的长期结局。
方法：回顾了1983年2月1日至2023年12月31日在明尼苏达大学进行的所有成人胰腺移植，包括单纯胰腺移植(PTA),胰肾同步移植（SPK），肾移植（PAK）后的胰腺。
结果：在2353例移植中，发现了110例PTLD，总体发病率为4.8%。17.3％在移植后1年内被诊断出，32.7%在5年内确诊，在5年后诊断出74例（67.3%）。PTLD的总体30年发病率因移植类型而异-PTA为7.4％，SPK的14.2%，PAK为19.4%（p=0.3）。在多变量分析中，年龄和EB病毒血清阴性是PTLD的危险因素，PTLD是患者死亡的危险因素。PTLD特异性死亡率为32.7%，尽管与没有PTLD的受者相比，有PTLD的受者移植后中位生存期相似(14.9年vs.15.6年，p=0.9)。
结论：胰腺移植后的PTLD与显著的死亡率相关。尽管PTLD的发病率随着时间的推移而下降，在EBV阴性的受者中,对PTx后PTLD的怀疑指数应该仍然很高.
方法：回顾了1983年2月1日至2023年12月31日在明尼苏达大学进行的所有成人胰腺移植，包括单纯胰腺移植(PTA),胰肾同步移植（SPK），肾移植（PAK）后的胰腺。
结果：在2353例移植中，发现了110例PTLD，总体发病率为4.8%。17.3％在移植后1年内被诊断出，32.7%在5年内确诊，在5年后诊断出74例（67.3%）。PTLD的总体30年发病率因移植类型而异-PTA为7.4％，SPK的14.2%，PAK为19.4%（p=0.3）。在多变量分析中，年龄和EB病毒血清阴性是PTLD的危险因素，PTLD是患者死亡的危险因素。PTLD特异性死亡率为32.7%，尽管与没有PTLD的受者相比，有PTLD的受者移植后中位生存期相似(14.9年vs.15.6年，p=0.9)。
结论：胰腺移植后的PTLD与显著的死亡率相关。尽管PTLD的发病率随着时间的推移而下降，在EBV阴性的受者中,对PTx后PTLD的怀疑指数应该仍然很高.
