Epstein-Barr virus hepatitis after liver transplantation.
OBJECTIVE
The purpose of this study was to review our experience with Epstein-Barr virus (EBV) hepatitis after liver transplantation.


METHODS
During a 68-month period, we performed 668 liver transplants and 585 patients. We identified 11 patients (2 percent), including 5 adults and 6 children with EBV hepatitis after liver transplantation. The diagnosis of EBV hepatitis was established by evaluating allograft biopsies. The histology was confirmed by the use of polymerase chain reaction technology.


RESULTS
The average time of diagnosis after liver transplantation was 45 days. Eight of eleven cases occurred within the first six months after transplantation. After the diagnosis of EBV hepatitis, treatment consisted of a decrease in immunosuppression plus antiviral therapy and intravenous immunoglobulin. The one-year actuarial survival for patients with EBV hepatitis, was 73 percent (8 of 11). Two patients died of progressive multi-organ EBV involvement. To determine the risk of developing EBV hepatitis, we reviewed our experience with the administration of antilymphocyte preparations in 585 patients. The patients found to have a significantly greater risk of developing EBV hepatitis included those receiving more than one course of antilymphocyte therapy or greater than a total dose of 70 milligrams of OKT3 in a single course.


CONCLUSIONS
EBV hepatitis after liver transplantation is an infrequent event, which may be treated successfully. The occurrence of EBV hepatitis appears closely linked to the use of antilymphocyte preparations.
Department of Surgery, University of Nebraska Medical Center, Omaha.
A N
AN
Langnas
R S
RS
Markin
M
M
Inagaki
R J
RJ
Stratta
M F
MF
Sorrell
J P
JP
Donovan
B W
BW
Shaw
D000328:Adult; D002648:Child; D006525:Hepatitis, Viral, Human / Q000175:diagnosis / Q000209:etiology* / Q000276:immunology / Q000401:mortality; D006566:Herpesviridae Infections / Q000175:diagnosis / Q000209:etiology* / Q000276:immunology / Q000401:mortality; D004854:Herpesvirus 4, Human; D006801:Humans; D016867:Immunocompromised Host; D016031:Liver Transplantation / Q000009:adverse effects; D015996:Survival Rate; D014412:Tumor Virus Infections / Q000175:diagnosis / Q000209:etiology* / Q000276:immunology / Q000401:mortality