肾移植后淋巴组织增生性疾病四例并文献复习

摘要

Objective To study the clinicopathologic features of post-transplant lymphoproliferative disorders (PTLD) following renal transplantation.Methods Four cases of PTLD following renal transplantation were studied and relevant literatures were reviewed.Results All the 4 cases had received 3-drug-immunosuppression after transplantation.The duration between renal transplantation and diagnosis of PTLD was 5-112 months,averagely 34 months.The patients were suffered from infective monocytic hyperplasialike PTLD,plasmacytic hyperplasialike PTLD,polymorphic PTLD and monomorphic PTLD respectively in morphology and had no specific symptoms.All the patients received therapy with dosage reduction of immunosuppressants and some received rituximab or chemotherapy.The case of monomorphic PTLD died in a short time after diagnosis.Conclusion PTLD is a lymphoproliferative disease with distinctive morphologic and clinical characteristics.The main treatments include the dosage reduction of immunosuppressive agents,biotherapy and chemotherapy.The prognosis of monomorphic PTLD is poor.%目的 探讨肾移植后淋巴组织增生性疾病(PTLD)的病理特点、临床表现、诊治及预后.方法 回顾性分析4例肾移植后PTLD患者的临床病理资料,并对相关文献进行复习.结果 4例患者肾移植术后均采用三联免疫抑制疗法,移植后至PTLD诊断时间为5～ 112个月,平均34个月.病理组织学类型:2例早期病变(浆细胞增生和传染型单核细胞增生样PTLD各1例),1例多形性PTLD,1例单一型PTLD.均无特异性临床表现,确诊后均予免疫抑制剂减量,或辅以利妥昔单抗和化疗.单一型PTLD患者在短期内死亡,余患者均生存.结论 PTLD是发生在器官移植后具有独特形态和临床特征的淋巴组织增生异常；治疗上以免疫抑制剂减量、生物治疗和化疗为主；单一型PTLD预后差.