Roles of Epstein–Barr virus viral load monitoring in the prediction of posttransplant lymphoproliferative disorder in pediatric liver transplantation

Chen, Ho-Sheng; Ho, Ming-Chih; Hu, Rey‐Heng; Wu, Jia‐Feng; Chen, Huey‐Ling; Ni, Yen‐Hsuan; Hsu, Hong–Yuan; Jeng, Yung‐Ming

doi:10.1016/j.jfma.2018.12.007

Cited by 16 publications

(22 citation statements)

References 25 publications

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“…Yancoski et al also predicted the incidence of PTLD at 95.8% sensitivity and 71.4% specificity when the cutoff level of EBV titer was 6215 copies/mL . Data from Taiwan pediatric liver transplant cohort suggested that EBV DNAemia over 4100 copies/mL within 3 months following liver transplant was the predictor of PTLD . Routine EBV PCR monitoring makes it possible to apply the pre‐emptive management to prevent progression to PTLD by reduction of immunosuppression in pediatric SOT recipients.…”

Section: Discussionmentioning

confidence: 99%

Epstein‐Barr viral load monitoring for diagnosing post‐transplant lymphoproliferative disorder in pediatric liver transplant recipients

Seo

Kim

et al. 2020

Pediatric Transplantation

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This study aimed to investigate the incidence of PTLD in pediatric liver transplant recipients and the risk factors for the development of PTLD. We also determined clinically useful quantitative EBV PCR parameters for aiding in the diagnosis of EBV-associated PTLD in the pediatric liver transplant recipients at our institute. We reviewed children < 18 years old who had undergone liver transplantations and quantitative analysis of whole blood EBV load at our institute from January 2006 to March 2015. A total of 142 liver transplant recipients were included, and their median age was 1.5 years. Clinically significant high-level EBV DNAemia ≥ 10 000 copies/mL at least twice was observed in 53.5% and PTLD occurred in 9.9%. Among PTLD group, graft failure and mortality rate were as high as 21.4% and 14.3%, respectively.Deceased donor, presence of high-level EBV DNAemia, and primary CMV infection following transplant were associated with an increased risk for PTLD in the multivariate analysis. The peak titer at 10 875 copies/mL could be used as a cutoff value with a sensitivity of 92.9% and a specificity of 37.9%; the rate of increase in EBV load suggested a sensitivity of 64.3% and a specificity of 70.9% at the cutoff value of 44 000 copies/mL/week. In conclusion, the incidence of PTLD following liver transplant in children was as high as 10%. PTLD is associated with significant morbidity and mortality. Close monitoring of EBV DNAemia is crucial for the early diagnosis and proper treatment of PTLD in pediatric liver transplant recipients. K E Y W O R D S Epstein-Barr virus, pediatric liver transplantation, post-transplant lymphoproliferative disorders How to cite this article: Seo E, Kim J, Oh SH, Kim KM, Kim DY, Lee J. Epstein-Barr viral load monitoring for diagnosing post-transplant lymphoproliferative disorder in pediatric liver transplant recipients. Pediatr Transplant. 2020;24:e13666.

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Section: Discussionmentioning

confidence: 99%

Epstein‐Barr viral load monitoring for diagnosing post‐transplant lymphoproliferative disorder in pediatric liver transplant recipients

Seo

Kim

et al. 2020

Pediatric Transplantation

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“…4 In any case, close serial monitoring of EBV DNA is considered useful for early diagnosis and prevention of PTLD and EBV-related diseases. [6][7][8] Although EBV is one virus that cause hepatitis (infectious mononucleosis), most pediatric recipients with chronic high EBV loads (CHEBV) are asymptomatic and the high viral load resolves spontaneously. 9 Some studies proposed reduced IS for the treatment of EBV infection after transplantation to prevent the development of PTLD, 10,11 while it has been reported that such dose reduction of IS leaded to the progression of graft fibrosis.…”

Section: Introductionmentioning

confidence: 99%

“…Regarding therapy for EBV DNAemia, it has been reported that antivirals did not prevent EBV infection or chronic high‐load carriage; moreover, reduction/discontinuation of immunosuppressants (IS) might not also improve persistent EBV DNAemia 4 . In any case, close serial monitoring of EBV DNA is considered useful for early diagnosis and prevention of PTLD and EBV‐related diseases 6–8 …”

Section: Introductionmentioning

confidence: 99%

The impact of chronic Epstein–Barr virus infection on the liver graft of pediatric liver transplant recipients: A retrospective observational study

Shizuku

Kamei

Yoshizawa

et al. 2021

Transplant Infectious Dis

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“…Close monitoring of EBV viral load within 3 months after LT is helpful to predict a high risk of PTLD. Tapering of immunosuppressants is suggested if the EBV viral load is >4100 copies/mg PBMC DNA in LT children 4 . Although PTLD is often associated with Epstein‐Barr virus (EBV) infection, approximately 10% of these paediatric PTLD patients are EBV‐DNA negative and show poor prognosis 5 …”

Section: Introductionmentioning

confidence: 99%

“…Tapering of immunosuppressants is suggested if the EBV viral load is >4100 copies/mg PBMC DNA in LT children. 4 Although PTLD is often associated with Epstein-Barr virus (EBV) infection, approximately 10% of these paediatric PTLD patients are EBV-DNA negative and show poor prognosis. 5 A definitive diagnosis of PTLD requires pathological analysis.…”

Section: Introductionmentioning

confidence: 99%

Post‐transplant lymphoproliferative disorder after paediatric liver transplantation

et al. 2020

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Objective The purpose of this study was to analyse the clinical and pathological characteristics, treatments and outcomes of post‐transplant lymphoproliferative disorder (PTLD) in paediatric liver transplant recipients. Method A retrospective analysis of records from nine paediatric liver transplant recipients with PTLD who were treated at our Liver Transplant Center over the period from June 2013 to August 2018. Result Of these nine patients, seven received liver transplantation in our centre and the remaining two patients at other hospitals. The overall incidence of PTLD in paediatric liver transplant recipients in our centre was 1.4% (7/485). The median onset of PTLD after liver transplantation was 11 months. Three cases were classified as infectious mononucleosis PTLD, one case was plasmacytic hyperplasia PTLD, one case was polymorphic PTLD and two cases were Burkitt lymphoma. One case showed diffuse large B‐cell lymphoma and one was classical Hodgkin lymphoma‐like PTLD. These patients presented with different clinical manifestations including fever, anaemia, diarrhoea, hypoproteinaemia, enlargement of lymph nodes, hepatosplenomegaly, jaundice, bowel obstruction and even intestinal perforation. Nine patients were positive for EBV‐DNA in serum. After diagnosis, immunosuppressants were reduced or discontinued in all cases. Eight patients received anti‐CD20 monoclonal antibody (Rituximab) therapy, four cases were treated with a combination of chemotherapy (R‐CHOP, ABVD, COPP/ABV) and one case was combined with radiotherapy. Two cases received surgical treatment due to bowel obstruction. Eight of these patients achieved a complete remission and remained healthy when assessed at the time of final follow‐up. One patient died as a result of PTLD progression. Conclusion PTLD is one of the most serious and fatal complications after liver transplantation. The definitive diagnosis requires histopathology. Treatment varies and basically includes immunosuppression reduction, anti‐CD20 antibody, surgery, radiotherapy and chemotherapy.

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Roles of Epstein–Barr virus viral load monitoring in the prediction of posttransplant lymphoproliferative disorder in pediatric liver transplantation

Cited by 16 publications

References 25 publications

Epstein‐Barr viral load monitoring for diagnosing post‐transplant lymphoproliferative disorder in pediatric liver transplant recipients

Epstein‐Barr viral load monitoring for diagnosing post‐transplant lymphoproliferative disorder in pediatric liver transplant recipients

The impact of chronic Epstein–Barr virus infection on the liver graft of pediatric liver transplant recipients: A retrospective observational study

Post‐transplant lymphoproliferative disorder after paediatric liver transplantation

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