肝移植术后肝门恶性淋巴瘤(附2例报道)

目的 分析肝移植术后肝脏局部淋巴增生性疾病(LL-PTLD)的临床和病理特点,结合文献总结LL-PTLD防治措施.方法回顾性分析本中心2例肝移植术后肝门局部淋巴瘤的临床、病理资料.结果 2例均因肝移植术后出现发热、黄疸、肝门血管闭塞、胆道梗阻、肝门占位进行二次移植.病例1为T细胞性淋巴瘤,供体来源,二次移植术后6个月因肝门淋巴瘤复发死亡;病例2为B细胞性淋巴瘤,供体来源,术后4个月死于肺感染.2例淋巴瘤EBV病毒LMP均为阳性.结论 肝移植术后肝门局部淋巴瘤不宜进行二次移植,对那些PTLD高危病例(供体EBV阳性/受体EBV阴性),术后应使用低剂量免疫抑制剂,常规应用抗病毒药物;对于出现无法解释的肝门部梗阻病例,应高度怀疑LL-PTLD的存在,可考虑针吸活检,尽早确诊并采取适当措施治疗.

Occurrence of hilar malignant lymphoma after liver transplantation:A report of two cases

Objective To analyse the clinical and pathological characteristics of liver-localized post liver transplantation lymphoproliferative disease(LL-PTLD), and review the therapeutics in literature. Methods Two cases of post liver transplant hilar lymphoma were analyzed retrospectively. Results The two cases presented with fever, jaundice, obstruction of hilar structures underwent re-transplantation at 6, 5 months after the first liver transplantation respectively. Case 1 was a T-cell lymphoma a originated from donor's cells, dead of hilar lymphoma recurrence at 6 months after re-transplantation. Case 2 was a B-cell lymphoma also originated from donor's cells. who dead of sever lung infection at 4 months after operation. EBV-LMP is positive in the 2 lymphomas. Conclusion LL-PTLD is not indication for re-transplantation. It should be treated with low doses of immunosuppresants and use acyclovir or ganciclovir for preventing the persistence of episomal form of EBV associated with latency for the high risk cases (R-/D ); For cases presented with symptoms of fever, chills associated with jaundice and without reasonable explaination,LL-PTLD should be suspected and diagnosis and treatment should be done promptly.