Viral load of EBV DNAemia is a predictor of EBV-related post-transplant lymphoproliferative disorders in pediatric renal transplant recipients

Colombini, Elisa; Guzzo, Isabella; Morolli, Federica; Longo, Germana; Russo, Cristina; Lombardi, Alessandra; Merli, Pietro; Barzon, Luisa; Murer, Luisa; Piga, Simone; Atti, Marta Luisa Ciofi degli; Locatelli, Franco; Strologo, Luca Dello

doi:10.1007/s00467-017-3627-2

Cited by 39 publications

(58 citation statements)

References 30 publications

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“…The role of EBV in the pathogenesis of PTLD is well documented; however, EBV-DNA load was not associated with true positive FDG-PET/CT results in our study [26]. EBV monitoring is a common clinical practice for early PTLD detection and various studies have advocated its importance as a predictor of PTLD development [3,[27][28][29][30][31]. Nonetheless, EBV-DNA load does not seem to affect the detection performance of FDG-PET/CT.…”

Section: Current Guidelines From the British Committee For Standards contrasting

confidence: 51%

Diagnostic performance of FDG-PET/CT of post-transplant lymphoproliferative disorder and factors affecting diagnostic yield

Jesus

Kwee

Kahle

et al. 2019

Eur J Nucl Med Mol Imaging

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Purpose Post-transplant lymphoproliferative disorder (PTLD) is a serious complication after solid organ and hematopoietic stem cell transplantation, requiring a timely and accurate diagnosis. In this study, we evaluated the diagnostic performance of FDG-PET/CT in patients with suspected PTLD and examined if lactate dehydrogenase (LDH) levels, Epstein-Barr virus (EBV) load, or timing of FDG-PET/CT relate to detection performance of FDG-PET/CT. Methods This retrospective study included 91 consecutive patients with clinical suspicion of PTLD and a total of 97 FDG-PET/CT scans within an 8-year period. Pathology reports and a 2-year follow-up were used as the reference standard. Diagnostic performance of FDG-PET/CT for detection of PTLD as well as logistic regression analysis for factors expected to affect diagnostic yield were assessed. Results The diagnosis of PTLD was established in 34 patients (35%). Fifty-seven FDG-PET/CT scans (59%) were true negative, 29 (30%) were true positive, 6 (6%) false positive, and 5 (5%) false negative. Sensitivity of FDG-PET/CT for the detection of PTLD was 85%, specificity 90%, positive predictive value 83%, and negative predictive value 92%, with good inter-observer variability (k = 0.78). Of the parameters hypothesized to be associated with a true positive FDG-PET/CT result for the diagnosis of PTLD, only LDH was statistically significant (OR 1.03, p = 0.04). Conclusion FDG-PET/CT has a good diagnostic performance in patients suspected of PTLD, with a good inter-observer agreement. Only LDH levels seemed to influence the detection performance of FDG-PET/CT. EBV-DNA load and timing of FDG-PET/CT after transplantation did not affect FDG-PET/CT diagnostic yield.

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Section: Current Guidelines From the British Committee For Standards contrasting

confidence: 51%

Diagnostic performance of FDG-PET/CT of post-transplant lymphoproliferative disorder and factors affecting diagnostic yield

Jesus

Kwee

Kahle

et al. 2019

Eur J Nucl Med Mol Imaging

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“…Approximately 5 × 10 5 copies/mL of EBV DNA was detected in our patients with EBV disease. Colombini et al have reported that the mean maximum EBV viral load was 3.4 × 10 8 copies/mL in paediatric renal recipients who tested positive for EBV and 1.9 × 10 7 copies/mL in patients who tested negative for EBV . In another study, EBV viral load at diagnosis was 2.5 × 10 4 copies/mL in the primary EBV infection group and 600 copies/mL in the EBV reactivation group .…”

Section: Discussionmentioning

confidence: 98%

Epstein–Barr virus infection in children with renal transplantation: A single‐centre experience

et al. 2018

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“…Indeed, they consider PTLD histopathology independently of time of onset since transplantation . They separate disease into 1/plasma cell hyperplasia, which corresponds to early PTLD with exuberant lymphoid proliferation and preservation of normal tissue architecture despite the presence of a mass effect (such as enlarged lymph nodes, tonsils, adenoid hypertrophy), 2/non‐early PTLD with polymorphic PTLD (polyclonal or monoclonal), and monomorphic PTLD, in which the normal architecture of the involved tissue is partially or completely destroyed.…”

Section: Introductionmentioning

confidence: 99%

Pediatric renal transplantation: A retrospective single‐center study on epidemiology and morbidity due to EBV

Laurent

Klich

Roy

et al. 2018

Pediatric Transplantation

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Pediatric R-Tx patients are at high risk of developing EBV primary infection. Although high DNA replication is a risk factor for PTLD, some patients develop PTLD with low viral load. In this retrospective single-center study including all pediatric patients having received R-Tx (2003-2012 period), we aimed to identify risk factors for uncontrolled reactions to EBV (defined as the presence of a viral load >10 000 copies/mL or PTLD). A Cox proportional hazard model was performed. A total of 117 patients underwent R-Tx at a mean age of 9.7 ± 5.3 years, 46 of them being seronegative for EBV at the time of R-Tx. During follow-up, 54 patients displayed positive EBV viral load, 22 of whom presenting with primary infection. An uncontrolled reaction to EBV was observed in 24 patients, whilst 4 patients developed PTLD. Univariate and multivariate analyses suggested the following risk factors for an uncontrolled reaction: age below 5 years, graft from a deceased donor, ≥5 HLA mismatches, EBV-seronegative status at the time of R-Tx, and a secondary post-Tx loss of anti-EBNA. Monitoring anti-EBNA after R-Tx may contribute to the early identification of patients at risk for uncontrolled reaction.

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Viral load of EBV DNAemia is a predictor of EBV-related post-transplant lymphoproliferative disorders in pediatric renal transplant recipients

Abstract: A high PCR EBV viral load is correlated with the probability of developing PTLD. The definition of a reliable marker is essential to identify patients more at risk of PTLD and to personalize the clinical approach to the single patient.

Cited by 39 publications

References 30 publications

Diagnostic performance of FDG-PET/CT of post-transplant lymphoproliferative disorder and factors affecting diagnostic yield

Diagnostic performance of FDG-PET/CT of post-transplant lymphoproliferative disorder and factors affecting diagnostic yield

Epstein–Barr virus infection in children with renal transplantation: A single‐centre experience

Pediatric renal transplantation: A retrospective single‐center study on epidemiology and morbidity due to EBV

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