A Scheduled Program of Molecular Screening for Epstein-Barr Virus Decreases the Incidence of Post-transplantation Lymphoproliferative Disease in Pediatric Liver Transplantation

Soriano-López, D.P.; Alcántar-Fierros, J.M.; Hernández-Plata, J.A.; González-Jorge, A.L.; Velázquez-Ramos, S.; Flores-Hernandez, Marissa; Fuentes, Virginia Luis; Castañeda, P.; Nieto, José; Sánchez, Javier; Lopez, Briseida; Valencia-Mayoral, Pedro; Varela-Fascinetto, Gustavo

doi:10.1016/j.transproceed.2016.02.031

Cited by 13 publications

(5 citation statements)

References 18 publications

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“…However, it is noteworthy that 89% of PTLD cases after 2006 were classified as lymphoma, differing from the period before this year when we had a rate of 34% ( p = .009); that is, the milder forms of the disease (nondestructive and polymorphic) seem to have been avoided by early interventions triggering by detecting a high EBV viral load, avoiding its progression to lymphoproliferative disorder. A similar study was conducted by Soriano‐López and collaborators in Mexico City, where a reduction in the incidence of PTLD from 14.9% to only 1.9% was observed, after monitoring with PCR for EBV was started 21 ; our study showed a reduction from 5.4% to 3.6%.…”

Section: Discussionsupporting

confidence: 88%

Seropositivity for cytomegalovirus and PCR‐EBV monitoring: Protective factors for posttransplant lymphoproliferative disorder in pediatric liver transplant

Éboli

Tannuri

2022

Pediatric Transplantation

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Background: PTLD is a clinical condition with high mortality. Monitoring EBV replication can be a useful tool to avoid the development of PTLD. Materials and Methods:This was a retrospective analysis of 428 pediatric patients who underwent liver transplantation between 1989 and 2016. The patients were divided into 2 groups (transplanted before 2006, when PCR-EBV was not monitored, and after 2006, when PCR-EBV monitoring was started). Patients with continuous PCR measurements for EBV were evaluated for the impact of a reduction in immunosuppression or a change in immunosuppressants on the number of viral copies. A logistic regression model was applied to evaluate factors related to PTLD. Results:The prevalence of PTLD was 4.2%. After monitoring patients with PCR for EBV levels, a predominance of the most severe, monomorphic form of lymphoproliferative disorder was observed (p = .009). The PTLD mortality was 5%. There was a change in the PCR level after tacrolimus reduction (p = .002) and after tacrolimus exchange for mTOR (p = .008). The number of EBV copies was significantly higher (p = .029) in patients who developed PTLD. In the multiple regression model, seropositivity for CMV was an independent protective factor for lymphoproliferative disorder (OR=0.09; 95% CI 0.02-0.42), reducing the chance of having PTLD adjusted by serology for EBV by 91%. Conclusions:Monitoring the EBV viral load by PCR seems to prevent the emergence of milder forms of lymphoproliferative disorder. Pretransplant seropositivity for CMV is a protective factor for PTLD.

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Section: Discussionsupporting

confidence: 88%

Seropositivity for cytomegalovirus and PCR‐EBV monitoring: Protective factors for posttransplant lymphoproliferative disorder in pediatric liver transplant

Éboli

Tannuri

2022

Pediatric Transplantation

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“…For early detection and furthermore prevention of PTLD, monitoring EBV viral load is considered as one of the crucial factors, even though the specificity and positive predictive value of EBV titer in predicting PTLD are still controversial24252627). As an example, right after that regular EBV viral load monitoring was adopted as standard clinical practice, our center encountered only one case of pediatric PTLD during 2008–2012; Upon recognition of high titer of EBV of >10,000 copies/mL immunosuppression was reduced when possible, and active surveillance of PTLD was adopted.…”

Section: Discussionmentioning

confidence: 99%

Posttransplantation lymphoproliferative disorder after pediatric solid organ transplantation: experiences of 20 years in a single center

et al. 2017

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PurposeTo evaluate the clinical spectrum of posttransplantation lymphoproliferative disorder (PTLD) after solid organ transplantation (SOT) in children.MethodsWe retrospectively reviewed the medical records of 18 patients with PTLD who underwent liver (LT) or kidney transplantation (KT) between January 1995 and December 2014 in Seoul National University Children's Hospital.ResultsEighteen patients (3.9% of pediatric SOTs; LT:KT, 11:7; male to female, 9:9) were diagnosed as having PTLD over the last 2 decades (4.8% for LT and 2.9% for KT). PTLD usually presented with fever or gastrointestinal symptoms in a median period of 7 months after SOT. Eight cases had malignant lesions, and all the patients except one had evidence of Epstein-Barr virus (EBV) involvement, assessed by using in situ hybridization of tumor tissue or EBV viral load quantitation of blood. Remission was achieved in all patients with reduction of immunosuppression and/or rituximab therapy or chemotherapy, although 1 patient had allograft kidney loss and another died from complications of chemotherapy. The first case of PTLD was encountered after the introduction of tacrolimus for pediatric SOT in 2003. The recent increase in PTLD incidence in KT coincided with modification of clinical practice since 2012 to increase the tacrolimus trough level.ConclusionWhile the outcome was favorable in that all patients achieved complete remission, some patients still had allograft loss or mortality. To prevent PTLD and improve its outcome, monitoring for EBV infection is essential, which would lead to appropriate modification of immunosuppression and enhanced surveillance for PTLD.

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“…Although a biopsy is required for PTLD diagnosis, a rise in EBV-viral titers should be considered highly suspicious for EBV-associated PTLD [ 164 ]. In any case, a complete history needs to be provided with the specimen, as a careful clinicopathological correlation is essential for PTLD diagnosis.…”

Section: Ptldsmentioning

confidence: 99%

EBV-Driven Lymphoproliferative Disorders and Lymphomas of the Gastrointestinal Tract: A Spectrum of Entities with a Common Denominator (Part 3)

Zanelli

Sanguedolce

Palicelli

et al. 2021

Cancers

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EBV is the first known oncogenic virus involved in the development of several tumors. The majority of the global population are infected with the virus early in life and the virus persists throughout life, in a latent stage, and usually within B lymphocytes. Despite the worldwide diffusion of EBV infection, EBV-associated diseases develop in only in a small subset of individuals often when conditions of immunosuppression disrupt the balance between the infection and host immune system. EBV-driven lymphoid proliferations are either of B-cell or T/NK-cell origin, and range from disorders with an indolent behavior to aggressive lymphomas. In this review, which is divided in three parts, we provide an update of EBV-associated lymphoid disorders developing in the gastrointestinal tract, often representing a challenging diagnostic and therapeutic issue. Our aim is to provide a practical diagnostic approach to clinicians and pathologists who face this complex spectrum of disorders in their daily practice. In this part of the review, the chronic active EBV infection of T-cell and NK-cell type, its systemic form; extranodal NK/T-cell lymphoma, nasal type and post-transplant lymphoproliferative disorders are discussed.

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A Scheduled Program of Molecular Screening for Epstein-Barr Virus Decreases the Incidence of Post-transplantation Lymphoproliferative Disease in Pediatric Liver Transplantation

Cited by 13 publications

References 18 publications

Seropositivity for cytomegalovirus and PCR‐EBV monitoring: Protective factors for posttransplant lymphoproliferative disorder in pediatric liver transplant

Seropositivity for cytomegalovirus and PCR‐EBV monitoring: Protective factors for posttransplant lymphoproliferative disorder in pediatric liver transplant

Posttransplantation lymphoproliferative disorder after pediatric solid organ transplantation: experiences of 20 years in a single center

EBV-Driven Lymphoproliferative Disorders and Lymphomas of the Gastrointestinal Tract: A Spectrum of Entities with a Common Denominator (Part 3)

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