The role of quantitative Epstein-Barr virus polymerase chain reaction and preemptive immunosuppression reduction in pediatric liver transplantation: a preliminary experience.
BACKGROUND
Risk factors for the development of posttransplant lymphoproliferative disease (PTLD), a major cause of morbidity and mortality after pediatric liver transplantation, are primary Epstein-Barr virus (EBV) infection and intensity of immunosuppression. The authors assessed monitoring of EBV replication and preemptive immunosuppression reduction in pediatric liver transplant recipients.


METHODS
The authors prospectively followed monthly EBV-quantitative competitive polymerase chain reaction to measure EBV replication in 23 patients who underwent liver transplant between July 1997 and November 1998. Preemptive immunosuppression reduction was instituted for significant EBV replication. Patients were followed up for at least 1 year and divided in two groups for analysis (group 1, pretransplant seronegative for EBV [13 patients]; group 2, seropositive for EBV [10 patients]).


RESULTS
In group 1, 9 of 13 patients had positive polymerase chain reaction results at a mean time of 22.4 weeks after transplantation. All but one of these patients were asymptomatic. In seven of nine patients, preemptive immunosuppression reduction was undertaken without development of PTLD or rejection. In two of nine patients, immunosuppression could not be continuously reduced, and both patients experienced low-grade and medically responsive PTLD. In no patient in group 2 did an EBV-positive viral load or PTLD develop.


CONCLUSIONS
Prospective longitudinal measurement of EBV by quantitative competitive polymerase chain reaction permits early detection of asymptomatic viral replication. Subsequent preemptive reduction of immunosuppression may prevent the progression to PTLD.
Kogan-Liberman
D
D
Division of Pediatric Gastroenterology, Mount Sinai School of Medicine, New York, New York, USA.
Burroughs
M
M
Emre
S
S
Moscona
A
A
Shneider
B L
BL
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D020031:Epstein-Barr Virus Infections / Q000150:complications* / Q000635:transmission; D017809:Fatal Outcome; D005260:Female; D006084:Graft Rejection / Q000517:prevention & control; D004854:Herpesvirus 4, Human / Q000235:genetics / Q000302:isolation & purification; D006801:Humans; D007165:Immunosuppression Therapy / Q000009:adverse effects; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D007223:Infant; D007231:Infant, Newborn; D008232:Lymphoproliferative Disorders / Q000209:etiology* / Q000517:prevention & control* / Q000821:virology; D008297:Male; D016377:Organ Transplantation / Q000009:adverse effects*; D016133:Polymerase Chain Reaction; D011183:Postoperative Complications / Q000209:etiology* / Q000821:virology; D011446:Prospective Studies; D012307:Risk Factors; D016559:Tacrolimus / Q000008:administration & dosage; D019562:Viral Load
D007166:Immunosuppressive Agents; D016559:Tacrolimus