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Isolation and Quantification of Epstein-Barr Virus from the P3HR1 Cell Line
Published on: September 28, 2022
Epstein-Barr virus monitoring in paediatric renal transplant recipients
R Shroff1, R Trompeter, D Cubitt
1Department of Nephrology, Great Ormond Street Hospital for Children, London WC1N 3JH, UK.
Insights
Early Epstein-Barr virus (EBV) detection via plasma DNA testing in pediatric transplant recipients effectively preempts post-transplant lymphoproliferative disease by enabling timely immunosuppression reduction.
Area of Science:
- Virology
- Immunology
- Pediatric Medicine
Background:
- Post-transplant lymphoproliferative disease (PTLD) is a significant risk following organ transplantation.
- Epstein-Barr virus (EBV) reactivation or primary infection is a major contributor to PTLD.
- Early detection of EBV viremia is crucial for intervention.
Purpose of the Study:
- To assess the efficacy of prospective Epstein-Barr virus (EBV) DNA surveillance in plasma for early detection of viremia.
- To evaluate the impact of early EBV detection on the incidence of PTLD and graft function.
- To correlate EBV infection types (primary vs. reactivation) with clinical outcomes.
Main Methods:
- Prospective surveillance using qualitative polymerase chain reaction (PCR) for EBV DNA in plasma of pediatric transplant recipients.
- Monitoring of EBV serostatus pre-transplant.
- Correlation of EBV viremia with immunosuppressive regimens (quadruple therapy/tacrolimus vs. cyclosporine-based).
- Assessment of clinical outcomes, including PTLD development, serum creatinine levels, and renal function.
Main Results:
- Twenty of 43 children (44%) developed EBV viremia.
- Primary EBV infection was associated with delayed onset, symptomatic disease, and increased serum creatinine.
- Higher incidence of EBV disease observed in children on quadruple therapy with tacrolimus compared to cyclosporine.
- Prompt reduction of immunosuppression upon EBV detection led to resolution of symptoms and normalization of renal function in all patients.
Conclusions:
- Prospective EBV DNA surveillance is effective in early detection of viremia in pediatric transplant recipients.
- Early detection facilitates timely immunosuppression reduction, preventing severe complications like PTLD.
- This surveillance strategy is associated with favorable outcomes, including preserved renal function.
Abstract:
Prospective Epstein-Barr virus (EBV) surveillance post transplant was undertaken by qualitative polymerase chain reaction testing for EBV DNA in plasma so as to detect EBV viremia as early as possible and thereby attempt to pre-empt post-transplant lymphoproliferative disease by reduction of immunosuppression. Forty-three children (46 transplants) were followed for a median (range) of 15.5 (3-25) months. Thirty-one children (67%) were EBV seropositive pre transplant. Twenty children (44%) developed EBV viremia; of these 9 (60%) were seronegative and 11 (36%) seropositive recipients. Primary infection developed later (median difference 14.2 weeks, P=0.009), was more likely to be symptomatic (odds ratio 2.91, 95% confidence interval 0.95-4.88) and associated with a rise in serum creatinine (odds ratio 6.13, 95% confidence interval 4.13-8.13) than reactivation disease. There was a higher incidence of EBV disease in children receiving quadruple therapy and tacrolimus (odds ratio 13.2, 95% confidence interval 11.5-14.9) compared with those given cyclosporin-based immunosuppression. Immunosuppression was reduced when EBV infection was detected. All children became asymptomatic and renal function returned to normal by a median (range) of 17 (6-52) days, although mild relapses occurred in 3 children. Regular EBV surveillance allowed prompt reduction of immunosuppression and was associated with a good outcome in this group of children.
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