title: Adolescents are more likely to develop posttransplant lymphoproliferative disorder after primary Epstein-Barr virus infection than younger renal transplant recipients.
abstract: BACKGROUND
  Primary Epstein-Barr virus (EBV) infection is the most important risk factor for development of posttransplant lymphoproliferative disorder (PTLD). Pediatric patients are often EBV seronegative pretransplant placing them at high risk. In the immune-competent population, primary herpesvirus infection is associated with higher morbidity with increasing age.
  
  
  METHODS
  We performed a retrospective cohort study to describe the outcome of pediatric renal transplant recipients with primary EBV infection. All patients received 3 months of ganciclovir prophylaxis. Real-time quantitative polymerase chain reaction was used to determine the EBV viral load. Primary EBV infection was categorized as PTLD, symptomatic infection, or subclinical infection.
  
  
  RESULTS
  There were a total of 46 patients with primary EBV infection: 11 developed PTLD, 12 had symptomatic infection, and 23 had subclinical infection. Adolescents were significantly more likely to develop PTLD than younger transplant recipients (P=0.05, chi-square). Multivariate analysis using logistic regression found that older age was the only significant risk factor for PTLD (odds ratio 1.24, 95% confidence interval 1.04-1.47; P=0.03). Among the 11 cases of PTLD, there were two deaths and two graft failures which all occurred in adolescent recipients (P=0.002).
  
  
  CONCLUSIONS
  Among pediatric renal transplant recipients with primary EBV infection, adolescents are at significantly higher risk to develop PTLD and have poorer outcomes compared to younger recipients.
authors.affiliation: Department of Pediatrics, Division of Nephrology, Children's Hospital and Regional Medical Center, University of Washington, Seattle, WA 98105, USA. jodi.smith@seattlechildrens.org
authors.forename: Jodi M
authors.initials: JM
authors.lastname: Smith
authors.forename: Lawrence
authors.initials: L
authors.lastname: Corey
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Healey
authors.forename: Connie L
authors.initials: CL
authors.lastname: Davis
authors.forename: Ruth A
authors.initials: RA
authors.lastname: McDonald
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D020031:Epstein-Barr Virus Infections / Q000150:complications* / Q000209:etiology* / Q000821:virology; D005260:Female; D006084:Graft Rejection / Q000209:etiology; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects*; D016015:Logistic Models; D008232:Lymphoproliferative Disorders / Q000150:complications / Q000209:etiology* / Q000401:mortality; D008297:Male; D015999:Multivariate Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D019562:Viral Load