title: Impact of immunosuppression on the development of Epstein-Barr virus (EBV) viremia after pediatric liver transplantation.
abstract: OBJECTIVE
  Pediatric liver transplant (OLT) patients are at risk of posttransplant lymphoproliferative disease (PTLD) from Epstein-Barr virus (EBV). This study examined the impact of induction and immunosuppression on EBV viremia.
  
  
  METHODS
  A retrospective chart review was performed on 197 pediatric patients and induction regimen, immunosuppression levels, and EBV viremia were documented for 1 year post-OLT. Logistic regression models determined associations between induction, immunosuppression, and EBV.
  
  
  RESULTS
  Fifty six percent of patients developed EBV viremia. Incidence of EBV viremia was 73% with antithymocyte globulin (ATG), 63% with daclizumab, and 39% for neither, though the trend was not significant [ATG: odds ratio (OR) 0.19; 95% confidence interval (CI) 0.024-1.58; P = .125; daclizumab OR; 1.07; 95% CI 0.270-4.23; P = .925]. Tacrolimus immunosuppression levels were supratherapeutic 28.7% of the time; however, only supratherapeutic tacrolimus levels between 0 and 2 weeks increased EBV viremia at 2 to 4 weeks post-OLT (OR 1.80; 95% CI 1.10-2.94; P = .02). Three patients developed PTLD.
  
  
  CONCLUSIONS
  The use of ATG and daclizumab induction likely does not play a role in the development of EBV viremia. Supratherapeutic tacrolimus levels 0 to 2 weeks post-OLT impact the development of EBV viremia at 2 to 4 weeks. The incidence of PTLD was low, suggesting better EBV and immunosuppression monitoring plays an important role in reducing PTLD.
authors.affiliation: Pediatric Gastroenterology, Hepatology, and Nutrition, Lucile Packard Children's Hospital, Stanford University Medical Center, Palo Alto, California, USA. lubr@sutterhealth.org
authors.forename: B R
authors.initials: BR
authors.lastname: Lu
authors.forename: K T
authors.initials: KT
authors.lastname: Park
authors.forename: M
authors.initials: M
authors.lastname: Hurwitz
authors.forename: K L
authors.initials: KL
authors.lastname: Cox
authors.forename: W E
authors.initials: WE
authors.lastname: Berquist
mesh_terms: D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use; D000961:Antilymphocyte Serum / Q000627:therapeutic use; D002648:Child; D000077561:Daclizumab; D020031:Epstein-Barr Virus Infections / Q000209:etiology*; D004854:Herpesvirus 4, Human; D006801:Humans; D007074:Immunoglobulin G / Q000627:therapeutic use; D007165:Immunosuppression Therapy / Q000009:adverse effects / Q000379:methods*; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D015994:Incidence; D016031:Liver Transplantation / Q000009:adverse effects / Q000379:methods*; D008232:Lymphoproliferative Disorders / Q000209:etiology; D016017:Odds Ratio; D012044:Regression Analysis; D012189:Retrospective Studies; D014766:Viremia / Q000209:etiology*
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D000961:Antilymphocyte Serum; D007074:Immunoglobulin G; D007166:Immunosuppressive Agents; D000077561:Daclizumab