Monitoring of Epstein-Barr virus load and antibody in pediatric renal transplant patients.
BACKGROUND
Epstein-Barr virus (EBV) infection can lead to life-threatening post-transplant lymphoproliferative disorder (PTLD). The aim of the present study was to establish EBV monitoring methods to prevent PTLD.


METHODS
EBV-DNA load was investigated, using real-time polymerase chain reaction (PCR) and anti-EBV antibody titers, in peripheral blood mononuclear cells of 21 renal transplant patients (seven recipients who were EBV-seronegative, R[-]; 14 who were EBV-seropositive, R[+]) before grafting. The mean age at entry and the mean follow-up period was 7.8 years of age (range, 3.3-12.0 years) and 1.8 years (range, 0.4-4.0 years), respectively, in the R(-) group, and 12.5 years of age (range, 3.9-17.7 years) and 3.8 years (range, 0.8-8.2 years) in the R(+) group, respectively.


RESULTS
The mean maximum load of the EBV genome was 1071 copies/microg DNA (range, 106-20700 copies/microg DNA) in the R(-) group, and 61 copies/microg DNA (range, <50-552 copies/microg DNA) in the R(+) group. During follow up no patient in the R(+) group had any noticeable symptoms that could be related to EBV, but three recipients in the R(-) group developed EBV-related symptoms including adenoid hypertrophy, cervical lymphadenopathy, and PTLD (B cell lymphoma), in one patient each. In the R(-) group the first leukocyte-associated viremia was detected at 30-180 days, and seroconversion at 43-266 days after transplantation.


CONCLUSIONS
Viral DNA detection using PCR is a useful tool for EBV surveillance, but the maximum EBV load was not markedly elevated (2474 copies/microg DNA) in a patient with PTLD. Therefore, EBV surveillance using only monitoring of EBV load in peripheral leukocyte may be insufficient. Histology may therefore be necessary to accurately diagnose PTLD.
Sato
Tetsuya
T
Department of Pediatrics, Kochi Medical School, Kochi University, Kohasu Oko, Nankoku, Kochi, Japan.
Fujieda
Mikiya
M
Tanaka
Eriko
E
Miyamura
Masakazu
M
Chikamoto
Hiroko
H
Hisano
Masataka
M
Akioka
Yuko
Y
Ishiura
Yoshihito
Y
Dohno
Sumitaka
S
Maeda
Akihiko
A
Hattori
Motoshi
M
Wakiguchi
Hiroshi
H
D000293:Adolescent; D000914:Antibodies, Viral / Q000097:blood; D002648:Child; D002675:Child, Preschool; D004279:DNA, Viral / Q000032:analysis; D005260:Female; D004854:Herpesvirus 4, Human / Q000235:genetics / Q000276:immunology / Q000302:isolation & purification*; D006801:Humans; D016030:Kidney Transplantation; D008232:Lymphoproliferative Disorders / Q000821:virology; D008297:Male; D008991:Monitoring, Physiologic; D016133:Polymerase Chain Reaction; D011183:Postoperative Complications; D019562:Viral Load
D000914:Antibodies, Viral; D004279:DNA, Viral