肾移植后非霍奇金淋巴瘤十例报告

Clinical study of non-Hodgkin lymphoma after kidney transplantation： A report of 10 cases

目的探讨肾移植后非霍奇金淋巴瘤（NHL）的临床特点以及诊断和治疗方法。方法回顾性分析1998年1月至2011年1月单中心同种异体肾移植2045例的资料，其中术后发生NHL10例，发生率为0．49％。患者中男性和女性各5例，发病时年龄为30-59岁，肾移植后首次确诊NHL距离第1次肾移植的时间为（128．5±116．3）个月。结果患者病变部位包括胃部3例、皮肤2例、咽淋巴环2例（其中软腭1例、扁桃体1例）、子宫1例、肝脏1例、颅内1例。10例经病理检查均为弥漫性大B细胞淋巴瘤。确诊NHL后首选环磷酰胺＋多柔比星＋长春新碱＋泼尼松（CHOP）方案化疗，2008年后部分病例加用利妥昔单抗。10例患者随访截止时全部存活，其中时间最长者在确诊NHL后已存活14年。结论肾移植后NHL的临床诊断较困难，病理诊断是唯一的确诊手段。对肾移植后长期存活的患者，应加强随访监测，以早期发现和诊断NHL。

Objective To investigate the clinical feature, diagnosis and treatment of posttransplant lymphoproliferative disorders （PTLD） especially non-Hodgkin lymphoma （NHL） after renal transplantation. Methods All adult kidney recipients between Jan. 1, 1998 and Jan. 31, 2011 were prospectively reviewed, and 10 developed NHL （5 men and 5 women）. The NHL cumulative incidence was 0. 49%. Patients＇ age at the time of diagnosis was 30-59 years old, and NHL was diagnosed （128. 5 ± 116. 25） months after the first renal transplantation. The incidence, risk and prognostic factors of the patients with NHL were analyzed. Results The lesions were located diversely, including stomach （3 cases）, skin （2 cases）, soft palate （1 case）, tonsil （1 case）, uterus （1 case）, liver （1 case） and central nervous system （1 case）. Pathologically, all the 10 patients were diagnosed as diffuse large B-cell lymphoma （DLBCL）. After the diagnosis of NHL, the first choice of therapy was chemotherapy with CHOP plan. Since 2008, Rituximab was used in combination with CHOP plan. During the follow-up period, all the 10 patients survived, and longest survival time after diagnosis of NHL was 14 years. Conclusion The diagnosis of NHL after renal transplantation is difficult. The pathological diagnosis is the only way of confirming NHL. For those with a long survival after renal transplantation, it is important to diagnose NHL as early as possible.