Incidence and outcome of primary Epstein-Barr virus infection and lymphoproliferative disease in pediatric heart transplant recipients.
BACKGROUND
The objective of this study was to assess the relationship between Epstein-Barr virus (EBV) infection and posttransplantation lymphoproliferative disease (PTLD) in pediatric heart transplant recipients. EBV is implicated in the development of PTLD. However, the relationship between primary EBV infection and PTLD is not well understood.


METHODS
Serial EBV titers were determined prospectively in 50 children before and after heart transplantation. Results were correlated with the development of PTLD. The clinical presentation, management, and outcome of PTLD were characterized.


RESULTS
Before transplantation, EBV titers were positive in 19 and negative in 31 patients. After transplantation, all EBV-positive patients remained positive; 1 developed PTLD. Among EBV-negative patients, 12 of 31 remained negative; none developed PTLD. Nineteen patients demonstrated serologic evidence of primary EBV infection after heart transplantation; 12 developed PTLD. Mean follow-up after heart transplantation was 3.3 years (range 0.4 to 8.4 years). Mean time from heart transplantation to histologic confirmation of PTLD was 29 months (range 3 to 72 months). Survival with PTLD was 92%.


CONCLUSIONS
Twelve of 13 pediatric heart transplant recipients who developed PTLD had evidence of primary EBV infection. Serial monitoring of EBV titers may lead to earlier identification and improved treatment of PTLD.
Zangwill
S D
SD
Department of Pediatrics, College of Physicians and Surgeons, Columbia University, New York, NY, USA.
Hsu
D T
DT
Kichuk
M R
MR
Garvin
J H
JH
Stolar
C J
CJ
Haddad
J
J
Stylianos
S
S
Michler
R E
RE
Chadburn
A
A
Knowles
D M
DM
Addonizio
L J
LJ
D000293:Adolescent; D000914:Antibodies, Viral / Q000032:analysis; D000998:Antiviral Agents / Q000008:administration & dosage; D002648:Child; D002675:Child, Preschool; D020031:Epstein-Barr Virus Infections / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D005260:Female; D016027:Heart Transplantation / Q000009:adverse effects*; D004854:Herpesvirus 4, Human / Q000302:isolation & purification; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D008232:Lymphoproliferative Disorders / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D008297:Male; D012307:Risk Factors
D000914:Antibodies, Viral; D000998:Antiviral Agents; D007166:Immunosuppressive Agents