Monitoring of Epstein–Barr Viral Load in Pediatric Heart and Lung Transplant Recipients by Real-time Polymerase Chain Reaction

Benden, Christian; Aurora, Paul; Burch, Michael; Cubitt, David; Lloyd, Cathryn; Whitmore, P; Neligan, Sophie L.; Elliott, Martin J.

doi:10.1016/j.healun.2005.06.014

Cited by 49 publications

(33 citation statements)

References 19 publications

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“…Recent studies have also called attention to the effect of asymptomatic Epstein-Barr virus (EBV), human herpesvirus 6 (HHV-8), and HHV-7 viremia in solid organ transplantation. [21][22][23][24][25][26][27] A recent study by Bingler et al 23 suggests that a high-load EBV carrier state (Ͼ16,000 genome copies/ ml) is a strong predictor of de novo or recurrent posttransplant lymphoproliferative disorder in a pediatric heart transplant population. An interesting recent study suggests that EBV viremia could also be associated with the development of bronchiolitis obliterans in lung transplant recipients.…”

Section: Discussionmentioning

confidence: 99%

Changing trends in infectious disease in heart transplantation

Haddad

Deuse

Pham

et al. 2010

The Journal of Heart and Lung Transplantation

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Section: Discussionmentioning

confidence: 99%

Changing trends in infectious disease in heart transplantation

Haddad

Deuse

Pham

et al. 2010

The Journal of Heart and Lung Transplantation

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“…18,20,30 Nevertheless, higher viral load may be obtained in patients with primary EBV infection after transplantation than in those with reactivation (i.e., seropositive patients before transplantation), although these patients also have a high risk of developing PTLD. 31,32 Therefore, the type of immunosuppression and the doses of ATG should be carefully considered after organ transplantation, especially in infants and young children, who will make their first contact with EBV when they are already receiving immunosuppression and when they may not be able to generate an adequate T-cell immune response. 21,30 …”

Section: Discussionmentioning

confidence: 99%

Relationship of Immunosuppression to Epstein–Barr Viral Load and Lymphoproliferative Disease in Pediatric Heart Transplant Patients

Schubert¹,

Renner²,

Hammer³

et al. 2008

The Journal of Heart and Lung Transplantation

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“…Patients with a persistently elevated level of circulating EBV may have an increased risk of PTLD[2,9]. Previously, a single center study reported that a high EBV load did not predict PTLD in early post-heart and heart-lung transplant period[10]. However, another single center study suggested that exposure to EBV and higher intensity immunosuppression was associated with increased risk of PTLD in pediatric HT recipients[11].…”

Section: Introductionmentioning

confidence: 99%

Persistent Epstein-Barr viral load in Epstein-Barr viral naïve pediatric heart transplant recipients: Risk of late-onset post-transplant lymphoproliferative disease

Das

Morrow

Huang

et al. 2016

WJT

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AIMTo examine the risk of late-onset post-transplant lymphoproliferative disorder (PTLD) in the presence of persisting high Epstein-Barr virus (EBV) in EBV naïve pediatric heart transplant (HT) recipients.METHODSA retrospective review of the medical records of the 145 pediatric HT recipients who had serial EBV viral load monitoring at our center was performed. We defined EBV naive patients whose EBV serology either IgM or IgG in the blood were negative at the time of HT and excluded passive transmission from mother to child in subjects less than 6 mo of age.RESULTSPTLD was diagnosed in 8 out of 145 patients (5.5%); 6/91 (6.5%) in those who were EBV seropositive and 2/54 (3.7%) in the EBV naïve group at the time of HT (P = 0.71). We found 32/145 (22%) patients with persistently high EBV load during continuing follow-up; 20/91 (22%) in EBV seropositive group vs 12/54 (22%) in EBV naïve group (P = 0.97). There was no significant association between pre-HT serostatus and EBV load after transplant (P > 0.05). In the EBV seropositive group, PTLD was diagnosed in 15% (3/20) of patients with high EBV vs 4.2% (3/71) of patients with low or undetectable EBV load (P = 0.14) whereas in EBV naïve patients 8.3% (1/12) of those with high EBV load and 2.3% (1/42) with low or undetectable EBV load (P = 0.41). There was a highly significant association between occurrence of PTLD in those with high EBV load and duration of follow up (4.3 ± 3.9 years) after HT by Cochran-Armitage test for the entire cohort (P = 0.005). At least one episode of acute rejection occurred in 72% (23/32) of patients with high EBV vs 36% (41/113) patients with low or undetectable EBV after HT (P < 0.05).CONCLUSIONThere is an association between persistently high EBV load during post-HT follow up and the occurrence of late-onset PTLD in pediatric HT recipients irrespective of serostatus at the time of transplant. The occurrence of allograft rejection increased in patients with high EBV load presumably due to reduction in immunosuppression.

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Monitoring of Epstein–Barr Viral Load in Pediatric Heart and Lung Transplant Recipients by Real-time Polymerase Chain Reaction

Cited by 49 publications

References 19 publications

Changing trends in infectious disease in heart transplantation

Changing trends in infectious disease in heart transplantation

Relationship of Immunosuppression to Epstein–Barr Viral Load and Lymphoproliferative Disease in Pediatric Heart Transplant Patients

Persistent Epstein-Barr viral load in Epstein-Barr viral naïve pediatric heart transplant recipients: Risk of late-onset post-transplant lymphoproliferative disease

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