title: Epidemiology and morbidity of Epstein-Barr virus infection in pediatric renal transplant recipients: a multicenter, prospective study.
abstract: BACKGROUND
  The epidemiology and morbidity of Epstein-Barr virus (EBV) infection in pediatric renal transplant recipients have been characterized insufficiently.
  
  
  METHODS
  In a prospective, multicenter study among 106 pediatric kidney allograft recipients aged 11.4 ± 5.9 years, we investigated the epidemiology of EBV infection and the relationship between EBV load, EBV serology, and EBV-related morbidity (posttransplant lymphoproliferative disease [PTLD] or symptomatic EBV infection, defined as flu-like symptoms or infectious mononucleosis).
  
  
  RESULTS
  EBV primary infection occurred in 27 of 43 (63%) seronegative patients and reactivation/reinfection in 28 of 63 (44%) seropositive patients. There was no association between the degree or duration of EBV load and EBV-related morbidity: The vast majority (17 of 18 [94%]) of patients with a high, persistent EBV load remained PTLD-free throughout a follow-up of 5.0 ± 1.3 years, while 2 of 3 (66%) patients with EBV-related PTLD exhibited only a low EBV load beforehand. Eight of 18 (44%) patients with a high, persistent EBV load remained asymptomatic during a follow-up of 5.3 ± 2.9 years. Multivariate analysis identified the EBV high-risk (D(+)/R(-)) serostatus (odds ratio [OR], 7.07; P < .05), the presence of human leukocyte antigen (HLA)-DR7 (OR, 5.65; P < .05), and the intensity of the immunosuppressive therapy (OR, 1.53; P < .01) as independent risk factors for the development of a symptomatic EBV infection.
  
  
  CONCLUSIONS
  Presence of EBV high-risk seroconstellation, HLA-DR7, and intensity of immunosuppressive therapy are significant risk factors for a symptomatic EBV infection, whereas there is no close association between the degree or duration of EBV load and EBV-related morbidity. Clinical Trials Registration. NCT00963248.
authors.affiliation: University Children's Hospital, Im Neuenheimer Feld 430, D-69120 Heidelberg, Germany.
authors.forename: Britta
authors.initials: B
authors.lastname: Höcker
authors.forename: Helmut
authors.initials: H
authors.lastname: Fickenscher
authors.forename: Henri-Jacques
authors.initials: HJ
authors.lastname: Delecluse
authors.forename: Stephan
authors.initials: S
authors.lastname: Böhm
authors.forename: Uta
authors.initials: U
authors.lastname: Küsters
authors.forename: Paul
authors.initials: P
authors.lastname: Schnitzler
authors.forename: Martin
authors.initials: M
authors.lastname: Pohl
authors.forename: Ulrike
authors.initials: U
authors.lastname: John
authors.forename: Markus J
authors.initials: MJ
authors.lastname: Kemper
authors.forename: Henry
authors.initials: H
authors.lastname: Fehrenbach
authors.forename: Marianne
authors.initials: M
authors.lastname: Wigger
authors.forename: Martin
authors.initials: M
authors.lastname: Holder
authors.forename: Monika
authors.initials: M
authors.lastname: Schröder
authors.forename: Heiko
authors.initials: H
authors.lastname: Billing
authors.forename: Alexander
authors.initials: A
authors.lastname: Fichtner
authors.forename: Reinhard
authors.initials: R
authors.lastname: Feneberg
authors.forename: Anja
authors.initials: A
authors.lastname: Sander
authors.forename: Sabine
authors.initials: S
authors.lastname: Köpf-Shakib
authors.forename: Caner
authors.initials: C
authors.lastname: Süsal
authors.forename: Burkhard
authors.initials: B
authors.lastname: Tönshoff
mesh_terms: D000293:Adolescent; D000704:Analysis of Variance; D000998:Antiviral Agents / Q000627:therapeutic use; D002648:Child; D020031:Epstein-Barr Virus Infections / Q000453:epidemiology* / Q000276:immunology / Q000628:therapy / Q000821:virology; D005260:Female; D006084:Graft Rejection / Q000188:drug therapy / Q000517:prevention & control; D004854:Herpesvirus 4, Human / Q000276:immunology / Q000302:isolation & purification*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016030:Kidney Transplantation / Q000706:statistics & numerical data*; D008232:Lymphoproliferative Disorders / Q000453:epidemiology / Q000209:etiology / Q000821:virology; D008297:Male; D009017:Morbidity; D011446:Prospective Studies; D018709:Statistics, Nonparametric; D019737:Transplants / Q000706:statistics & numerical data; D019562:Viral Load
chemical_list: D000998:Antiviral Agents; D007166:Immunosuppressive Agents