探讨成人肾移植受者移植后淋巴增殖性疾病(PTLD)的临床特征和转归。

回顾性分析浙江大学医学院附属第一医院2013年9月1日至2024年8月30日肾移植术后确诊PTLD的41例肾移植受者临床资料。正态分布计量资料组间比较采用成组t检验；非正态分布计量资料组间比较采用Kruskal-Wallis检验；计数资料组间比较采用χ²检验或Fisher确切概率法。以受者死亡为观察终点，绘制Kaplan-Meier生存曲线，组间生存率比较采用log-rank检验。采用Cox比例风险模型分析影响受者生存的危险因素。连续变量的临界值由受试者操作特征曲线确认。P<0.05为差异有统计学意义。

随访截至2024年11月30日，14例受者死亡，27例存活。存活组与死亡组受者移植至PTLD确诊时间和多器官受累情况差异均有统计学意义(P均<0.05)。PTLD确诊时，存活组和死亡组受者血清肌酐分别为111.0(86.0~177.0)μmol/L和142.5(123.8~171.8)μmol/L，差异有统计学意义(H＝4.694，P<0.05)。41例肾移植受者确诊PTLD后平均总生存期为(83±11)个月(1~132个月)，移植至PTLD确诊时间>1年的受者生存率低于≤1年者(χ²＝4.044，P<0.05)；存在多器官受累受者生存率低于不存在者(χ²＝4.368，P<0.05)。多因素Cox比例风险回归分析示，移植至PTLD确诊时间>1年(HR＝0.108，95%CI：0.013~0.992)、乳酸脱氢酶>285 U/L(HR＝0.171，95%CI：0.034~0.874)和多器官受累(HR＝0.182，95%CI：0.039~0.856)均为影响PTLD受者生存的独立危险因素(P均<0.05)。接受R-序贯疗法与接受R-CHOP或其他含R化疗方案的受者生存率差异无统计学意义(χ²＝0.001，P>0.05)；治疗后达到淋巴瘤缓解的受者生存率高于未达到者(χ²＝15.859，P<0.05)。EB病毒(EBV)和CMV感染在早发型PTLD组中更为常见(P均<0.05)。

成人肾移植受者PTLD预后差，EBV和CMV感染常见于早发型PTLD；确诊PTLD至移植后间隔>1年、多器官受累和乳酸脱氢酶升高是影响受者生存的危险因素。

To investigate the clinical characteristics and outcomes of post-transplant lymphoproliferative disorder (PTLD) in adult kidney transplant recipients.

A retrospective analysis was conducted on the clinical data of 41 kidney transplant recipients diagnosed with PTLD at the First Affiliated Hospital, Zhejiang University School of Medicine from September 1, 2013, to August 30, 2024. Intergroup comparisons of normally distributed measurement data were performed using group t-test; non-normally distributed measurement data were compared using the Kruskal-Wallis test; categorical data were compared using the chi-square test or the Fisher′s exact test. Kaplan-Meier survival curves were plotted with recipient death as the endpoint, and intergroup survival rates were compared using the log-rank test. Cox proportional hazards model was used to analyze risk factors affecting recipient survival. Cutoff values for continuous variables were determined by receiver operating characteristic curves. A P-value <0.05 was considered statistically significant.

As of November 30, 2024, 14 recipients had died, and 27 were alive. Significant differences were observed between the survival and death groups in the time from transplantation to PTLD diagnosis and the situation of presence of multi-organ involvement (all P <0.05). At the time of PTLD diagnosis, serum creatinine levels were 111.0 (86.0-177.0) μmol/L in the survival group and 142.5 (123.8-171.8) μmol/L in the death group, with a statistically significant difference (H=4.694, P<0.05). The average overall survival period after PTLD diagnosis in the 41 kidney transplant recipients was (83±11) months (1-132 months). Recipients with a time from transplantation to PTLD diagnosis >1 year had a lower survival rate than those with≤1 year (χ²=4.044, P<0.05); recipients with multi-organ involvement had a lower survival rate than those without (χ²=4.368, P<0.05). Multivariate Cox proportional hazards regression analysis showed that a time from transplantation to PTLD diagnosis>1 year (HR=0.108, 95%CI: 0.013-0.992), lactate dehydrogenase>285 U/L (HR=0.171, 95%CI: 0.034-0.874), and multi-organ involvement (HR=0.182, 95%CI: 0.039-0.856) were independent risk factors affecting the survival of PTLD recipients (all P<0.05). There was no significant difference in survival rates between recipients receiving R-sequential therapy and those receiving R-CHOP or other R-containing chemotherapy regimens (χ²=0.001, P>0.05); recipients who achieved lymphoma remission after treatment had a higher survival rate than those who did not (χ²=15.859, P<0.05). Epstein-Barr virus (EBV) and CMV infections were more common in the early-onset PTLD group (all P<0.05).

Adult kidney transplant recipients who diagnosed with PTLD have a poor prognosis, EBV and CMV infections are more common in early-onset PTLD. Time of diagnosis >1 year post-transplantation, multi-organ involvement, and elevated lactate dehydrogenase levels are risk factors for survival.