A Scheduled Program of Molecular Screening for Epstein-Barr Virus Decreases the Incidence of Post-transplantation Lymphoproliferative Disease in Pediatric Liver Transplantation.
This is a cohort, retrospective, comparative study of all liver transplant recipients from a single center, from May 1998 to July 2015. Patients were divided into two groups according to the type of Epstein-Barr viral load monitoring. For group I (1998-2007), polymerase chain reaction (PCR) was not available or it was only qualitative with limited access. For group II (2008-2015), we used periodically scheduled quantitative PCR in plasma and leukocytes, with aggressive tapering of immunosuppression as soon as viral replication was detected. Ninety-eight recipients were included, 41 (41.8%) were Epstein-Barr virus (EBV) - seronegative before liver transplantation (LT). EBV replication was confirmed in 74 patients (75.5%), being more frequent in seronegative (87.8%) than seropositive patients (66.6%). Eight recipients (8.1%) developed post-transplantation lymphoproliferative disorder (PTLD) on average at 14.3 months post-LT, seven of eight were <3 years at LT, four of eight were D+/R- for EBV, and all had post-LT EBV replication confirmed by PCR. PTLD was classified as lymphoma (n = 4), polymorphic polyclonal (n = 3), and lymphoid hyperplasia (n = 1). Five patients died, and three cleared PTLD after immunosuppression tapering or interruption. There were no significant differences in the etiology, age at LT (5.6 vs. 7.3 years, P = .069), patients <4 years (53.2% vs. 35.3%, P = .103), or EBV seronegative recipients (44.7% vs. 37.3%, P = .54); however, the incidence of PTLD decreased from 14.9% to 1.9% (P = .026), and graft rejection from 51.1% to 29.4% (P = .039). One- and 5-year patient survival rates were 94.7% and 85%, respectively, with no differences between groups. This strategy dramatically decreased the incidence of PTLD (14.9% vs. 1.9%), without increasing the incidence of rejection; therefore, we recommend that it should be used in the follow-up of all pediatric LT recipients.
Department of Transplantation, Hospital Infantil de México Federico Gómez, México City, México.
D P
DP
Soriano-López
Department of Transplantation, Hospital Infantil de México Federico Gómez, México City, México.
J M
JM
Alcántar-Fierros
Department of Transplantation, Hospital Infantil de México Federico Gómez, México City, México.
J A
JA
Hernández-Plata
Department of Transplantation, Hospital Infantil de México Federico Gómez, México City, México.
A L
AL
González-Jorge
Department of Transplantation, Hospital Infantil de México Federico Gómez, México City, México.
S
S
Velázquez-Ramos
Department of Transplantation, Hospital Infantil de México Federico Gómez, México City, México.
M A
MA
Flores-Hernández
Department of Anesthesiology, Hospital Infantil de México Federico Gómez, México City, México.
V
V
Fuentes
Department of Anesthesiology, Hospital Infantil de México Federico Gómez, México City, México.
P
P
Castañeda
Department of Transplantation, Hospital Infantil de México Federico Gómez, México City, México.
J
J
Nieto
Department of Clinical Laboratory, Hospital Infantil de México Federico Gómez, México City, México.
J L
JL
Sánchez
Department of Clinical Laboratory, Hospital Infantil de México Federico Gómez, México City, México.
B
B
López
Department of Pathology, Hospital Infantil de México Federico Gómez, México City, México.
P
P
Valencia-Mayoral
Department of Transplantation, Hospital Infantil de México Federico Gómez, México City, México. Electronic address: varelafas@aol.com.
G
G
Varela-Fascinetto
D002648:Child; D002675:Child, Preschool; D042241:Early Diagnosis; D020031:Epstein-Barr Virus Infections / Q000175:diagnosis*; D005260:Female; D006084:Graft Rejection / Q000517:prevention & control; D004854:Herpesvirus 4, Human / Q000302:isolation & purification; D006801:Humans; D007165:Immunosuppression Therapy / Q000009:adverse effects; D016031:Liver Transplantation / Q000009:adverse effects*; D008223:Lymphoma / Q000517:prevention & control; D008232:Lymphoproliferative Disorders / Q000517:prevention & control*; D008297:Male; D009894:Opportunistic Infections / Q000517:prevention & control*; D016133:Polymerase Chain Reaction; D011183:Postoperative Complications / Q000517:prevention & control; D012189:Retrospective Studies; D019562:Viral Load