Significance of serial real-time PCR monitoring of EBV genome load in living donor liver transplantation.
BACKGROUND
Quantitative analysis of the Epstein-Barr virus (EBV) genome has been recently reported to be helpful for early identification of EBV viremia which could reduce the risk of post-transplantation lymphoproliferative disorder (PTLD).


OBJECTIVE
To demonstrate the significance of serial monitoring of EBV genome load by real-time quantitative polymerase chain reaction (PCR) after living donor liver transplantation.


METHODS
From March 1999 to April 2000, the EBV genome load in peripheral blood mononuclear cells (PBMNC) was measured serially in a total of 15 recipients of living donor liver transplantation (LDLT) who had a symptomatic EBV infection.


RESULTS
In 15 patients, the mean values of the highest EBV DNA levels from the patients who had fever, URS, diarrhea, ascites, lymphadenopathy and PTLD were 36 232, 16 040, 15 968, 2485, 336 858 and 60 486 copies/microg DNA, respectively. Patients were treated by reduction or discontinuation of immunosuppressives and/or antiviral agents. The EBV DNA levels decreased in all these patients following the recovery from their symptoms. We encountered two cases of PTLD during this study period. One of them was referred to us after the onset of PTLD and one had been undergoing aggressive immunosuppression treatment for severe rejection. Both were successfully treated.


CONCLUSIONS
Serial quantitative analysis of the EBV genome load by means of real-time PCR are thought to be useful for preventing PTLD through adjustment of the immunosuppression level in response to the viral genome load following symptomatic EBV infection.
Matsukura
Tadashi
T
Department of Transplantation Immunology, Kyoto University Hospital, Japan.
Yokoi
Akiko
A
Egawa
Hiroto
H
Kudo
Toyoichiro
T
Kawashima
Mayumi
M
Hirata
Yoshihiro
Y
Tanaka
Hirokazu
H
Kagajo
Kiyoko
K
Wada
Hiromi
H
Tanaka
Koichi
K
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D004279:DNA, Viral / Q000032:analysis*; D005260:Female; D004854:Herpesvirus 4, Human / Q000235:genetics / Q000302:isolation & purification*; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D007223:Infant; D007963:Leukocytes, Mononuclear / Q000821:virology; D016031:Liver Transplantation; D019520:Living Donors; D008232:Lymphoproliferative Disorders / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control / Q000821:virology; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D019562:Viral Load
D004279:DNA, Viral; D007166:Immunosuppressive Agents