Risk Factors and Survival Analysis of Epstein-Barr Virus Infection After Pediatric Liver Transplantation

To explore the risk factors affecting Epstein-Barr virus (EBV) infection after pediatric liver transplantation (PLT) and analyze the survival outcomes of EBV infection in PLT.

A retrospective analysis was conducted on clinical data from 251 pediatric patients (≤ 14 years) who underwent liver transplantation at West China Hospital of Sichuan University between January 1, 2008, and February 1, 2025. The cohort included 129 males and 122 females, with a median transplant age of 15 (10, 48) months. Patients were categorized into noninfection (n = 110), asymptomatic infection (n = 85), and symptomatic infection (n = 56) groups based on EBV infection status and severity. Clinical data were collected for univariate analysis, multivariate analysis, and Kaplan-Meier survival analysis.

Multivariate logistic regression analysis identified tacrolimus trough concentration, preoperative EBV infection in the recipient, and transplant age as independent risk factors for post-transplant EBV infection. The 1-, 3-, and 5-year survival rates were 94.7%, 92.2%, and 89.4% in the EBV-infected group, compared to 95.3%, 94.3%, and 93.1% in the noninfected group, with no significant difference in 5-year survival between the two groups (p = 0.376).

EBV infection is common after PLT, with a high incidence and potential for severe complications. Tacrolimus trough concentration, preoperative EBV infection, and age are independent risk factors for post-transplant EBV infection. EBV infection does not significantly impact long-term survival.