Timing of Epstein-Barr virus acquisition and the course of posttransplantation lymphoproliferative disorder in children.
BACKGROUND
To investigate the clinical course and risk factors of Epstein-Barr virus (EBV)-associated posttransplantation lymphoproliferative disorder (PTLD) after liver transplantation (LT) among children in Taiwan where children acquired EBV infection in early childhood.


METHODS
In the retrospective study, 67 children underwent LT in our hospital and survived for more than 3 months were recruited. Various predisposing risk factors, including viral status, nutritional status, age at transplantation, and medications, were assessed. The diagnosis of EBV-associated PTLD in these liver transplanted patients was confirmed by histologic examination.


RESULTS
Eight children developed EBV-associated PTLD after LT, and all (100%) had gastrointestinal tract mucosa-associated lymphoid tissue involvement with the initial presentation as bloody stool. The incidence of PTLD is 11.9% (8/67) in the liver transplanted children in our hospital. Children who received LT before 1 year of age had a higher risk of EBV-associated PTLD than others (relative risk [RR]=10.37, P=0.006). The absence of EBV nuclear antigen antibody in recipients before LT also increased the risk (RR=8.63, P=0.018). The RR of EBV-associated PTLD increased to 13.3 (P=0.002) in EBV naïve children who received LT before 1 year of age.


CONCLUSIONS
Additional risk of EBV naivity and transplantation age below 1 year was evident in our series to the development of EBV-associated PTLD. Acquired EBV infection in early infancy after the LT may increase the risk of gastrointestinal tract involvement of EBV-associated PTLD in Taiwan.
Wu
Jia-Feng
JF
Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan.
Ho
Ming-Chih
MC
Ni
Yen-Hsuan
YH
Chen
Huey-Ling
HL
Lu
Chun-Yi
CY
Hsu
Hong-Yuan
HY
Lee
Po-Huang
PH
Chang
Mei-Hwei
MH
D000293:Adolescent; D000410:Alanine Transaminase / Q000097:blood; D000998:Antiviral Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003586:Cytomegalovirus Infections / Q000517:prevention & control; D020031:Epstein-Barr Virus Infections / Q000453:epidemiology*; D005260:Female; D015774:Ganciclovir / Q000627:therapeutic use; D006084:Graft Rejection / Q000517:prevention & control; D004854:Herpesvirus 4, Human; D006801:Humans; D007223:Infant; D016031:Liver Transplantation / Q000009:adverse effects*; D008232:Lymphoproliferative Disorders / Q000453:epidemiology* / Q000821:virology*; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors
D000998:Antiviral Agents; D000410:Alanine Transaminase; D015774:Ganciclovir