Early Detection of Epstein-Barr Virus as a Risk Factor for Chronic High Epstein-Barr Viral Load Carriage at a Living-donor–dominant Pediatric Liver Transplantation Center

Abstract

Background. Epstein-Barr virus (EBV) infection and posttransplant lymphoproliferative disorders (PTLDs) after pediatric liver transplantation (LT) account for significant morbidity and mortality. Knowledge of EBV kinetics, epidemiology, and outcomes among pediatric living-donor LT cases is largely lacking. This study aims to provide clinical information related to EBV infection, chronic high EBV load (CHL) carriage, and PTLD at a living-donor–dominant pediatric LT center. Methods. A total of 5827 EBV load measurements from 394 LT recipients fulfilling inclusion criteria and their clinical data were analyzed. EBV loads >1000 copies/μg DNA (742 IU/μg DNA) were considered “high,” and CHL was defined by persistence >6 mo. Results. The highlighted results were as follows: (1) 94% of recipients underwent living-donor LT; (2) 80% of EBV seronegative recipients developed first EBV infection <2 y post-LT, and their EBV loads were consistently higher than those of seropositive recipients within <3 y post-LT but did not differ thereafter; (3) 61 (15%) recipients met CHL criteria, but none developed PTLD; (4) age <5 y, cytomegalovirus seronegative donors, and early development of EBV DNAemia <6 mo post-LT were independent risk factors for CHL; (5) the incidence of rejections after 1-y post-LT was comparably low among CHL carriers whose immunosuppression was minimized. Conclusions. Early detection of EBV following LT and CMV seronegative donors would facilitate risk stratification to prevent PTLD while titrating immunosuppression among pediatric LT recipients.

Chronic Epstein-Barr viral load carriage after pediatric organ transplantation

“…Age is another potential contributor to development of the CHL carrier state in pediatric SOT recipients. Multiple studies have found that age less than five years is an independent risk for CHL development, although the mechanism remains uncertain ( 19 ). Studies of otherwise healthy infants with primary EBV infection provide some potential explanations for this phenomenon.…”

“…The risk factors for developing either CHL or PTLD have been addressed in multiple observational and retrospective studies (4)(5)(6)(7)(8)19). Recipients who are EBV naïve prior to transplant and who are younger than five years of age are at high risk for the development of both EBV/PTLD and CHL carrier state (2,7,19).…”

“…The risk factors for developing either CHL or PTLD have been addressed in multiple observational and retrospective studies (4)(5)(6)(7)(8)19). Recipients who are EBV naïve prior to transplant and who are younger than five years of age are at high risk for the development of both EBV/PTLD and CHL carrier state (2,7,19). Therefore, the current guidelines recommend that patients at high risk for PTLD should be regularly monitored for the first-year post-transplant.…”