title: Identifying predictive factors for posttransplant lymphoproliferative disease in pediatric solid organ transplant recipients with Epstein-Barr virus viremia.
abstract: Epstein-Barr virus (EBV) viremia (EV) in pediatric solid organ transplant (SOT) recipients is a significant risk factor for posttransplant lymphoproliferative disease (PTLD) but not all patients with EV develop PTLD. We identify predictive factors for PTLD in patients with EV. We conducted a retrospective chart review of all pediatric SOT recipients (0 to 21 y) at a single institution between 2001 and 2009. A total of 350 pediatric patients received a SOT and 90 (25.7%) developed EV. Of EV patients, 28 (31%) developed PTLD. The median age at transplant was 11.5 months in the PTLD group and 21.5 months in the EV-only group (P=0.003). Twenty-three (37%) EV-only patients had immunosuppression increased before EV, compared with 28 (100%) of PTLD patients (P<0.001). The median peak EBV level was 3212 EBV copies/10 lymphocytes for EV-only and 8392.5 EBV copies/10 lymphocytes for PTLD (P=0.005). All patients who developed PTLD had ≥1 clinical symptoms. Younger age at transplant, increased immunosuppression before EV, higher peak EBV level, and presence of clinical symptoms have predictive value in the development of PTLD in SOT patients with EV.
authors.affiliation: *Division of Pediatric Hematology/Oncology, Children's Hospital at Montefiore, Bronx †Division of Pediatric Hematology/Oncology, Morgan Stanley Children's Hospital, New York Divisions of ¶Pediatric Nephrology #Pathology **Pediatric Hematology/Oncology, Mount Sinai Medical Center, New York, NY ‡Division of Pediatric Gastroenterology/Hepatology, Phoenix Children's Hospital, Phoenix, AZ §Division of Pediatric Gastroenterology, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL ∥Division of Pediatric Critical Care, North Carolina Children's Hospital, Chapel Hill, NC.
authors.forename: Lauren
authors.initials: L
authors.lastname: Weintraub
authors.forename: Chana
authors.initials: C
authors.lastname: Weiner
authors.forename: Tamir
authors.initials: T
authors.lastname: Miloh
authors.forename: Juli
authors.initials: J
authors.lastname: Tomaino
authors.forename: Umesh
authors.initials: U
authors.lastname: Joashi
authors.forename: Corinne
authors.initials: C
authors.lastname: Benchimol
authors.forename: James
authors.initials: J
authors.lastname: Strauchen
authors.forename: Michael
authors.initials: M
authors.lastname: Roth
authors.forename: Birte
authors.initials: B
authors.lastname: Wistinghausen
mesh_terms: D000293:Adolescent; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D020031:Epstein-Barr Virus Infections / Q000150:complications* / Q000276:immunology; D005260:Female; D006084:Graft Rejection / Q000188:drug therapy / Q000276:immunology; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects; D007223:Infant; D007231:Infant, Newborn; D008232:Lymphoproliferative Disorders / Q000175:diagnosis* / Q000276:immunology / Q000821:virology*; D008297:Male; D016377:Organ Transplantation / Q000009:adverse effects*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D018570:Risk Assessment; D014766:Viremia / Q000150:complications* / Q000276:immunology; D055815:Young Adult
chemical_list: D007166:Immunosuppressive Agents