Quantitative EBV viral loads and immunosuppression alterations can decrease PTLD incidence in pediatric liver transplant recipients

Am J Transplant. 2005 Sep;5(9):2222-8. doi: 10.1111/j.1600-6143.2005.01002.x.

Abstract

Epstein-Barr virus (EBV) is a common viral infection in pediatric liver transplant patients and can lead to development of post-transplant lymphoproliferative disorder (PTLD). Differing studies have used immunosuppression reduction, antiviral medications or i.v. CMV-immunogloublin for EBV prevention and treatment. The purpose of this study was to determine whether implementation of a protocol for frequent EBV monitoring and EBV viral load-driven immunosuppression reduction could decrease the incidence of PTLD in our patient population. All data were prospectively collected between 2001 and 2004 at a single institution. Seventy-three patients were entered into the study. Patients were divided into a historical control group (pre-2001, 30 patients) and a treatment group (post-2001, 43 patients). Approximately 1271 blood samples of 73 patients were collected between 2001 and 2004. Eleven out of 43 patients received immunosuppression tapering due to high EBV viral loads (>4000 copies/microg DNA). One patient developed allograft rejection after immunosuppression modulation. Prior to 2001, the incidence of PTLD at our institution was 16%. After instituting a protocol for EBV monitoring, the incidence of PTLD decreased to 2% (p-value<0.05). These findings illustrate that frequent EBV viral load monitoring and preemptive immunosuppression modulation have an integral role in preventing PTLD in the pediatric liver transplant population.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adolescent
  • Algorithms
  • Antiviral Agents / pharmacology
  • Child
  • Child, Preschool
  • Cytomegalovirus / immunology
  • DNA, Viral / analysis
  • Epstein-Barr Virus Infections / diagnosis*
  • Female
  • Herpesvirus 4, Human / metabolism*
  • Humans
  • Immune Tolerance
  • Immunoglobulins / immunology
  • Immunosuppression
  • Immunosuppressive Agents / pharmacology*
  • Infant
  • Liver Transplantation / adverse effects
  • Liver Transplantation / methods*
  • Lymphoproliferative Disorders / diagnosis*
  • Male
  • Postoperative Complications
  • Prospective Studies
  • Reverse Transcriptase Polymerase Chain Reaction
  • Time Factors
  • Viral Load*

Substances

  • Antiviral Agents
  • DNA, Viral
  • Immunoglobulins
  • Immunosuppressive Agents