Solid-organ transplant recipient on chronic immunosuppression ≥3 years post-transplant, b...

Детермінований перегляд YAML-сутності з джерельної бази. Клінічний авторитет лишається за вказаними source ID та статусом клінічного sign-off.

ID	`RF-IATROGENIC-TRANSPLANT-IMMUNOSUPPRESSION-LONGTERM-PREVENTION`
Тип	Тривожна ознака
Статус	переглянуто 2026-05-18 \| очікує клінічного підпису
Хвороби	`DIS-ANAL-SCC` `DIS-BCC` `DIS-CERVICAL` `DIS-DLBCL-NOS` `DIS-KAPOSI` `DIS-PTLD`
Джерела	`SRC-NCCN-ANAL-2025` `SRC-NCCN-BCELL-2025` `SRC-NCCN-CERVICAL-2025` `SRC-NCCN-SKIN-2025`

Походження тривожної ознаки

Визначення	Solid-organ transplant recipient on chronic immunosuppression ≥3 years post-transplant, beyond the high-acute-rejection window — the chronic- cohort persona. Distinct from the new-transplant cohort covered by RF-IATROGENIC-TRANSPLANT-IMMUNOSUPPRESSION-PREVENTION (which focuses on the acute / early window with EBV-DNA monitoring for PTLD, peri- transplant antiviral prophylaxis). Chronic-cohort risk profile shifts toward: cumulative skin-cancer burden (squamous-cell carcinoma 65-100x background; basal-cell carcinoma 10-20x; aggressive SCC subset prone to local recurrence + metastasis), late-onset post-transplant lymphoproliferative disorder (PTLD; late-onset PTLD ≥1y post-transplant more often EBV-negative, more diffuse-large-B-cell-like histology, worse prognosis than early-onset EBV-driven PTLD), Kaposi sarcoma in HHV-8-exposed cohort, cervical intraepithelial neoplasia / cervical cance...
Клінічний напрям	investigate
Категорія	other

Логіка спрацьовування

{
  "any_of": [
    {
      "finding": "post_solid_organ_transplant_immunosuppression_ge_3y",
      "value": true
    },
    {
      "finding": "post_allogeneic_hsct_chronic_immunosuppression_ge_3y",
      "value": true
    },
    {
      "finding": "years_post_transplant_ge_3_on_immunosuppression",
      "value": true
    }
  ],
  "type": "lab_value"
}

Нотатки

Prevention-persona RedFlag for chronic ≥3y post-transplant immunosuppression cohort. Engine routes to PreventionPlan with long-cycle surveillance cadence appropriate to the chronic cohort (vs the acute-window EBV-DNA cadence in the new-transplant RF). Distinct from RF-IATROGENIC-TRANSPLANT-IMMUNOSUPPRESSION- PREVENTION (which covers acute / new-transplant window). Both RFs may fire simultaneously in the early-chronic window (1-3y post-transplant) — engine routes to both surveillance tracks, render layer deduplicates overlapping recommendations. Anchored to DIS-DLBCL-NOS as the primary lymphoma anchor (late- onset PTLD histology more DLBCL-like; DIS-PTLD as the canonical early-onset EBV-driven entity). Multiple cancer types listed in relevant_diseases reflect the broad cumulative-risk profile of the chronic cohort. STUB pending two-Clinical-Co-Lead signoff per CHARTER §6.1 dev-mode.

Де використовується

Indications

IND-IATROGENIC-TRANSPLANT-IMMUNOSUPPRESSION-LONGTERM-PREVENTION-OBSERVATION - IND-IATROGENIC-TRANSPLANT-IMMUNOSUPPRESSION-LONGTERM-PREVENTION-OBSERVATION
IND-IATROGENIC-TRANSPLANT-IMMUNOSUPPRESSION-LONGTERM-PREVENTION-SURVEILLANCE - IND-IATROGENIC-TRANSPLANT-IMMUNOSUPPRESSION-LONGTERM-PREVENTION-SURVEILLANCE