title: Rituximab therapy for Epstein-Barr virus-related chronic hepatitis following living donor kidney transplantation.
abstract: A patient who underwent living donor kidney transplantation was infected with Epstein-Barr virus (EBV) that resulted in persistent EBV infection and EBV-associated chronic hepatitis, determined by abnormally elevated anti-EBV antibody titers and high frequency of EBV-infected B lymphocytes. Despite decreases in immunosuppressant doses, persistent EBV infection and chronic hepatitis persisted for several years. Therapy using anti-CD20 monoclonal antibody (rituximab) virtually eliminated peripheral B lymphocytes and EBV-encoded small RNA 1 (EBER-1)-positive cells. Moreover, hepatic enzyme levels normalized and histological findings indicated marked improvement in hepatic inflammation. Although peripheral CD20(+) B lymphocyte and EBER-1-positive cell levels began to increase 4 months after the end of therapy, the number of EBER-1-positive cells remained very low, and liver function test results remained within normal ranges. The present case illustrates the significance of early diagnosis, monitoring of viral load, and vigorous management of EBV-related disorders associated with organ transplantation.
authors.affiliation: Department of Pediatrics, Graduate School of Medical Science, Kanazawa University, Ishikawa 920-8641, Japan. kohta@ped.m.kanazawa-u.ac.jp
authors.forename: Kazuhide
authors.initials: K
authors.lastname: Ohta
authors.forename: Masaki
authors.initials: M
authors.lastname: Shimizu
authors.forename: Akiko
authors.initials: A
authors.lastname: Nakai
authors.forename: Tomoko
authors.initials: T
authors.lastname: Toma
authors.forename: Yoshihito
authors.initials: Y
authors.lastname: Kasahara
authors.forename: Chihiro
authors.initials: C
authors.lastname: Arii
authors.forename: Akihiro
authors.initials: A
authors.lastname: Yachie
authors.forename: Takeshi
authors.initials: T
authors.lastname: Kawamura
authors.forename: Atsushi
authors.initials: A
authors.lastname: Aikawa
authors.forename: Akira
authors.initials: A
authors.lastname: Hasegawa
authors.forename: Kazutaka
authors.initials: K
authors.lastname: Sato
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Yokoyama
authors.forename: Isao
authors.initials: I
authors.lastname: Ishikawa
authors.forename: Shoichi
authors.initials: S
authors.lastname: Koizumi
mesh_terms: D000293:Adolescent; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D058846:Antibodies, Monoclonal, Murine-Derived; D020031:Epstein-Barr Virus Infections / Q000188:drug therapy* / Q000473:pathology; D005260:Female; D006521:Hepatitis, Chronic / Q000188:drug therapy* / Q000473:pathology; D006525:Hepatitis, Viral, Human / Q000188:drug therapy* / Q000473:pathology; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use*; D016030:Kidney Transplantation; D008099:Liver / Q000473:pathology; D019520:Living Donors; D009395:Nephritis, Interstitial / Q000601:surgery; D011183:Postoperative Complications / Q000188:drug therapy*; D000069283:Rituximab
chemical_list: D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D007155:Immunologic Factors; D000069283:Rituximab