title: Characteristics of Epstein-Barr viraemia in adult liver transplant patients: a retrospective cohort study.
abstract: Therapeutic immunosuppression following solid organ transplantation increases the risk of Epstein-Barr (EBV) viraemia, which is implicated in post-transplant lymphoproliferative disease (PTLD). We retrospectively analysed the incidence of EBV viraemia and clinical outcomes in 98 liver transplant recipients. Patients underwent EBV DNA monitoring by whole-blood PCR: EBV levels were correlated with clinical parameters and outcomes for a median of 249 days. 67% patients developed EBV viraemia (EBV DNA ≥100 copies/ml) and 30% had sustained viraemia. There was a trend towards higher hazard ratios for viraemia with exposure to aciclovir (HR 1.57, P = 0.12) or in recipients of a poorly HLA-matched graft (HR 1.62, P = 0.10). These associations became significant in the subgroup with >90 days surveillance; HR 2.54 (P = 0.0015) for aciclovir and HR 1.99 (P = 0.03) for poorly matched grafts. The converse was true with ganciclovir (HR 0.56 P = 0.13). Viraemia was more prolonged in men (median duration 7 days vs 1; P = 0.01) and in those with lower UKELD scores (11 days vs 1 day; P = 0.001) but shortened with ganciclovir exposure (P = 0.06). Younger patients were more likely to have high peak viral loads (P = 0.07). No clinical signs or symptoms or adverse outcomes were associated with EBV reactivation.
authors.affiliation: Department of Virology, Royal Free London NHS Foundation Trust, London, UK.
authors.forename: Neil
authors.initials: N
authors.lastname: Halliday
authors.forename: Colette
authors.initials: C
authors.lastname: Smith
authors.forename: Claire
authors.initials: C
authors.lastname: Atkinson
authors.forename: James
authors.initials: J
authors.lastname: O'Beirne
authors.forename: David
authors.initials: D
authors.lastname: Patch
authors.forename: Andrew K
authors.initials: AK
authors.lastname: Burroughs
authors.forename: Douglas
authors.initials: D
authors.lastname: Thorburn
authors.forename: Tanzina
authors.initials: T
authors.lastname: Haque
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D004279:DNA, Viral / Q000097:blood; D020031:Epstein-Barr Virus Infections / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D006650:Histocompatibility Testing; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D019562:Viral Load; D014766:Viremia / Q000453:epidemiology* / Q000209:etiology
chemical_list: D004279:DNA, Viral
keywords: Epstein-Barr virus; infection; liver; transplantation