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Epstein-Barr virus infection after pediatric living-related liver transplantation--management and risk factors
T Shigeta1, K Imadome, S Sakamoto
1Department of Transplant Surgery, National Center for Child Health and Development, Setagaya, Tokyo, Japan. shigeta-t@ncchd.go.jp
Insights
Epstein-Barr virus (EBV) infection occurs in over 50% of pediatric liver transplant recipients, with donor seropositivity being a key risk factor. Early monitoring is crucial as EBV infection presents with diverse symptoms but did not lead to PTLD in this study.
Area of Science:
- Pediatric transplantation
- Virology
- Immunology
Background:
- Posttransplant lymphoproliferative disorder (PTLD) is a severe complication following pediatric liver transplantation.
- Epstein-Barr virus (EBV) infection is a significant risk factor for developing PTLD.
Purpose of the Study:
- To evaluate the risk factors, incidence, and clinical presentation of EBV infection in pediatric liver transplant recipients.
- To identify predictors of EBV infection post-transplantation.
Main Methods:
- Retrospective analysis of 81 children undergoing living-related liver transplantation (LRLT) between 2005 and 2009.
- Periodic EBV monitoring using real-time quantitative polymerase chain reaction.
- Univariate analysis to compare EBV-infected and non-infected groups.
Main Results:
- The incidence of EBV infection was 50.6%, with a mean onset of 276 days post-transplant.
- High-risk factors for EBV infection included a seropositive donor with a seronegative recipient and younger age at operation.
- Nine cases (22.5%) exhibited clinical symptoms, but no PTLD was observed.
Conclusions:
- EBV infection in pediatric liver transplant recipients has varied clinical presentations but did not result in PTLD in this cohort.
- Close monitoring for EBV, particularly in recipients with seropositive donors, is essential for preventing disease progression.
Introduction:
Posttransplant lymphoproliferative disorder (PTLD) is one of the severe complications after pediatric liver transplantation. Epstein-Barr virus (EBV) infection is a major risk factor developing PTLD. This study evaluates the risk factors, incidence, and clinical presentation of EBV infection at our institute.
Patients And Methods:
This study examines 81 children who underwent living-related liver transplantation (LRLT) from November 2005 to December 2009. The immunosuppression protocol consisted of tacrolimus and low-dose steroids, which were withdrawn by 3 months after LRLT. Additional immunosuppression was indicated for the selected cases because of recurrent rejection or renal insufficiency. Fifteen ABO blood type incompatible LRLTs were enrolled into this study. EBV was periodically monitored by the use of a real-time quantitative polymerase chain reaction (cut-off value, >10(2) copies/μg DNA). The median follow-up period was 637 days (range, 85 to 1548 days). These patients were divided into two groups: EBV infection versus EBV noninfection, for analysis of risk factors by univariate analysis.
Results:
The incidence of EBV infection was 50.6% (n = 41) with the mean onset of 276 ± 279 postoperative days (range, 7 to 1229 days). Nine cases (22.5%) presented clinical symptoms related to EBV infection, consisting of adenoid hypertrophy (n = 5), Evans's syndrome (n = 2), hemophagocytic syndrome (n = 1), and erythema nodosum (n = 1). There was no case of PTLD. The combination of a preoperative EBV seropositive donor and an EBV seronegative recipient was a high risk factor for postoperative EBV infection among the recipients (56.1% versus 26.8%, P < .05). The mean age at operation among the EBV infection group was younger than that of the EBV noninfection group (22 ± 30 months versus 62 ± 68 months; P < .05). The incidence of acute rejection episodes and cytomegalovirus infections; ABO blood type incompatible LRLT, and the length of steroid treatment and the additional immunosuppression were not significantly different between the two groups.
Conclusion:
There were various clinical presentations related to EBV infection; however, none of our patients developed PTLD. Careful monitoring of EBV infection especially for cases with donor seropositivity is important to prevent disease progression.
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