title: Quantitative EBV viral loads and immunosuppression alterations can decrease PTLD incidence in pediatric liver transplant recipients.
abstract: Epstein-Barr virus (EBV) is a common viral infection in pediatric liver transplant patients and can lead to development of post-transplant lymphoproliferative disorder (PTLD). Differing studies have used immunosuppression reduction, antiviral medications or i.v. CMV-immunogloublin for EBV prevention and treatment. The purpose of this study was to determine whether implementation of a protocol for frequent EBV monitoring and EBV viral load-driven immunosuppression reduction could decrease the incidence of PTLD in our patient population. All data were prospectively collected between 2001 and 2004 at a single institution. Seventy-three patients were entered into the study. Patients were divided into a historical control group (pre-2001, 30 patients) and a treatment group (post-2001, 43 patients). Approximately 1271 blood samples of 73 patients were collected between 2001 and 2004. Eleven out of 43 patients received immunosuppression tapering due to high EBV viral loads (>4000 copies/microg DNA). One patient developed allograft rejection after immunosuppression modulation. Prior to 2001, the incidence of PTLD at our institution was 16%. After instituting a protocol for EBV monitoring, the incidence of PTLD decreased to 2% (p-value<0.05). These findings illustrate that frequent EBV viral load monitoring and preemptive immunosuppression modulation have an integral role in preventing PTLD in the pediatric liver transplant population.
authors.affiliation: Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas, USA.
authors.forename: Timothy C
authors.initials: TC
authors.lastname: Lee
authors.forename: Barbara
authors.initials: B
authors.lastname: Savoldo
authors.forename: Cliona M
authors.initials: CM
authors.lastname: Rooney
authors.forename: Helen E
authors.initials: HE
authors.lastname: Heslop
authors.forename: Adrian P
authors.initials: AP
authors.lastname: Gee
authors.forename: Yvette
authors.initials: Y
authors.lastname: Caldwell
authors.forename: Neal R
authors.initials: NR
authors.lastname: Barshes
authors.forename: Jaymee D
authors.initials: JD
authors.lastname: Scott
authors.forename: Lisa J
authors.initials: LJ
authors.lastname: Bristow
authors.forename: Christine A
authors.initials: CA
authors.lastname: O'Mahony
authors.forename: John A
authors.initials: JA
authors.lastname: Goss
mesh_terms: D000293:Adolescent; D000465:Algorithms; D000998:Antiviral Agents / Q000494:pharmacology; D002648:Child; D002675:Child, Preschool; D003587:Cytomegalovirus / Q000276:immunology; D004279:DNA, Viral / Q000032:analysis; D020031:Epstein-Barr Virus Infections / Q000175:diagnosis*; D005260:Female; D004854:Herpesvirus 4, Human / Q000378:metabolism*; D006801:Humans; D007108:Immune Tolerance; D007136:Immunoglobulins / Q000276:immunology; D007165:Immunosuppression Therapy; D007166:Immunosuppressive Agents / Q000494:pharmacology*; D007223:Infant; D016031:Liver Transplantation / Q000009:adverse effects / Q000379:methods*; D008232:Lymphoproliferative Disorders / Q000175:diagnosis*; D008297:Male; D011183:Postoperative Complications; D011446:Prospective Studies; D020133:Reverse Transcriptase Polymerase Chain Reaction; D013997:Time Factors; D019562:Viral Load
chemical_list: D000998:Antiviral Agents; D004279:DNA, Viral; D007136:Immunoglobulins; D007166:Immunosuppressive Agents