Characteristics of Epstein-Barr virus primary infection in pediatric liver transplant recipients.
OBJECTIVE
Pediatric liver transplant recipients are at high risk of Epstein-Barr virus infection. However the incidence of clinical symptoms and the graft function at the time of acute infection remains poorly documented. The aim of this study was to monitor the clinical and biochemical events associated with primary Epstein-Barr virus infection.


METHODS
Clinical and biological patterns associated with Epstein-Barr virus infection were prospectively searched in 38 liver transplanted children. Polymerase chain reaction and anti-Epstein-Barr virus IgM antibodies were used at regular intervals to detect the timing of primary infection.


RESULTS
Five children (13%) had pretransplant immunity, 26 (68.5%) developed primary Epstein-Barr virus infection 15 to 90 days after transplantation and seven (18.5%) remained Epstein-Barr virus negative. The four patients with clinical symptoms at the time of infection subsequently developed post-transplant lymphoproliferative disease. A single post-transplant lymphoproliferative disease occurred in non-symptomatic patients (overall incidence 13%). No mortality was associated with post-transplant lymphoproliferative disease. Two asymptomatic patients had abnormal liver function tests possibly related to primary Epstein-Barr virus infection.


CONCLUSIONS
Epstein-Barr virus primary infection occurs in 80% of seronegative patients within 3 months after OLT. Clinical symptoms are rare and closely associated with post-transplant lymphoproliferative disease. Outside post-transplant lymphoproliferative disease, the consequences of infection are marginal.
Smets
F
F
Department of Pediatrics, Cliniques Universitaires Saint-Luc, Brussels, Belgium. Francoise.Smets@pedi.ucl.ac.be
Bodeus
M
M
Goubau
P
P
Reding
R
R
Otte
J B
JB
Buts
J P
JP
Sokal
E M
EM
D000293:Adolescent; D000410:Alanine Transaminase / Q000097:blood; D000956:Antigens, Viral / Q000032:analysis; D001219:Aspartate Aminotransferases / Q000097:blood; D002648:Child; D002675:Child, Preschool; D004279:DNA, Viral / Q000032:analysis; D005260:Female; D006566:Herpesviridae Infections / Q000097:blood / Q000209:etiology* / Q000821:virology; D004854:Herpesvirus 4, Human / Q000235:genetics / Q000276:immunology / Q000302:isolation & purification*; D006801:Humans; D007075:Immunoglobulin M / Q000032:analysis; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007223:Infant; D008107:Liver Diseases / Q000097:blood / Q000209:etiology* / Q000821:virology; D016031:Liver Transplantation / Q000009:adverse effects*; D008232:Lymphoproliferative Disorders / Q000097:blood / Q000209:etiology* / Q000821:virology; D008297:Male; D009894:Opportunistic Infections / Q000209:etiology; D016133:Polymerase Chain Reaction; D011446:Prospective Studies; D014412:Tumor Virus Infections / Q000097:blood / Q000209:etiology* / Q000821:virology; D005723:gamma-Glutamyltransferase / Q000097:blood
D000956:Antigens, Viral; D004279:DNA, Viral; D007075:Immunoglobulin M; D007166:Immunosuppressive Agents; D005723:gamma-Glutamyltransferase; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase