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

Abstract

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.

Guilty in absentia ‒ Cytomegalovirus seropositivity relates inversely to cancer incidence in race/ethnicity groups and worldwide: is latent viral infection oncopreventive?

“…1 ). Similar findings were described in animal in vitro tissue models [6][7][8] covering several oncological diseases [9][10][11]12]. This indicates that CMV infection may bestow a capacity on its host to resist carcinogenesis somewhat more effectively than does a normal immunity in an uninfected subject.…”

Cytomegalovirus infection may be oncoprotective against neoplasms of B-lymphocyte lineage: single-institution experience and survey of global evidence

“…In contrast, clinical evidence that favors an anti-limphoproliferative effect of CMV, recently came from de Carvalho Batista Éboli et al (2022). They verified liver pretransplant positivity for CMV as a protective factor for posttransplant lymphoproliferative disorder (PTLD) in pediatric patients [17]. A possible virus-vs-leukemia phenomenon has also been described [18], along with inhibition of migration of tumor cells [19,20].…”

“…(2022). They verified liver pretransplant positivity for CMV as a protective factor for posttransplant lymphoproliferative disorder (PTLD) in pediatric patients [ 17 ]. A possible virus- vs -leukemia phenomenon has also been described [ 18 ], along with inhibition of migration of tumor cells [ 19 , 20 ].…”