title: Sustained Epstein-Barr virus detection in paediatric liver transplantation. Insights into the occurrence of late PTLD.
abstract: Epstein-Barr virus (EBV) infection is the main cause of post-transplant lymphoproliferative disease (PTLD). Little is known on chronic carrier state and its relation with late PTLD. We aimed to study EBV infection in the long-term after paediatric liver transplantation (OLT). We conducted a retrospective review of 34 children monitored for a median of 5.8 years (range 1.5-17.7). 21 were IgG seronegative (group A) and 13 seropositive (group B) before OLT. Primary infection was the appearance of VCA-IgM or VCA-IgG or Real-Time Polymerase Chain Reaction (RT-PCR) in patients previously IgG seronegative; positive VCA-IgM or EA-IgG or RT-PCR lasting longer than 6 months was defined sustained viral detection (SVD). 18/21 patients of group A had a primary infection at a median time of 3 months after transplant (0.5-60). 14/18 of group A and 0/13 of group B had a SVD (P < 0.0001). Viral loads greater than 500 copies/10(5) mononuclear cells occurred in 12/18 patients in group A and 0/13 patients in group B (P < 0.0001). The 3 patients who developed late PTLD (median time after OLT 47 months, range 15-121) were from group A, and presented with SVD before developing PTLD. In conclusion, EBV infection in seronegative patients at OLT is associated with greater viral loads and sustained viral detection. Late PTLD occurred only in naïve patients with markers of SVD. Three to 4 monthly long-term monitoring of EBV in pre-OLT naïve patients might help preventing the occurrence of late PTLD.
authors.affiliation: Department of Paediatrics, University of Padua, Italy. lorenzo.dantiga@pediatria.unipd.it
authors.forename: Lorenzo
authors.initials: L
authors.lastname: D'Antiga
authors.forename: Monica
authors.initials: M
authors.lastname: Del Rizzo
authors.forename: Carlo
authors.initials: C
authors.lastname: Mengoli
authors.forename: Umberto
authors.initials: U
authors.lastname: Cillo
authors.forename: Graziella
authors.initials: G
authors.lastname: Guariso
authors.forename: Lucia
authors.initials: L
authors.lastname: Zancan
mesh_terms: D000293:Adolescent; D000914:Antibodies, Viral / Q000097:blood; D002648:Child; D002675:Child, Preschool; D020031:Epstein-Barr Virus Infections / Q000097:blood / Q000150:complications* / Q000175:diagnosis*; D005260:Female; D006084:Graft Rejection / Q000097:blood / Q000209:etiology; D004854:Herpesvirus 4, Human / Q000276:immunology; D006801:Humans; D007165:Immunosuppression Therapy / Q000009:adverse effects; D007223:Infant; D016031:Liver Transplantation / Q000009:adverse effects*; D008232:Lymphoproliferative Disorders / Q000097:blood / Q000821:virology*; D008297:Male; D015166:Monitoring, Immunologic / Q000379:methods; D012189:Retrospective Studies; D013997:Time Factors; D019562:Viral Load
chemical_list: D000914:Antibodies, Viral