Early Detection of Epstein-Barr Virus as a Risk Factor for Chronic High Epstein-Barr Viral Load Carriage at a Living-donor–dominant Pediatric Liver Transplantation Center
Early Detection of Epstein-Barr Virus as a Risk Factor for Chronic High Epstein-Barr Viral Load Carriage at a Living-donor–dominant Pediatric Liver Transplantation Center
复制标题
在以活体捐赠者为主的儿童肝移植中心早期发现 Epstein-Barr 病毒作为慢性高 Epstein-Barr 病毒载量携带的危险因素
作者：
Masaki Yamada;A. Fukuda;Miyuki Ogura;S. Shimizu;H. Uchida;Y. Yanagi;Yuriko Ishikawa;S. Sakamoto;M. Kasahara;K. Imadome
背景小儿肝移植术后EB病毒（EBV）感染和移植后淋巴组织增生性疾病（PTLDs）是导致严重并发症和死亡的重要原因。在儿科活体供者肝移植病例中，对EBV动力学、流行病学和预后的了解还很缺乏。本研究旨在提供一个以活体供者为主的儿科LT中心与EBV感染、慢性高EBV载量（CHL）携带和PTLD相关的临床信息。方法.共分析了394例符合纳入标准的LT接受者的5827项EBV载量测量及其临床资料。EBV载量>1000拷贝/μg DNA（742 IU/μg DNA）被认为是“高”，CHL被定义为持续时间>6个月。结果结果显示：（1）94%的受者接受了活体肝移植;（2）80%的EBV血清阴性受者在肝移植后2年内发生了首次EBV感染，其EBV载量在肝移植后3年内一直高于血清阳性受者，但此后无差异;（3）61例（15%）受者符合CHL标准，但无一例发生PTLD;（4）年龄<5岁、巨细胞病毒血清学阴性供体、移植后早期发生EB病毒DNA血症（<6个月）是CHL的独立危险因素;（5）在免疫抑制最小化的CHL携带者中，移植后1年的排斥反应发生率很低。结论. LT后早期检测EBV和CMV血清阴性供体将有助于风险分层，以预防PTLD，同时在儿科LT受者中滴定免疫抑制剂。
Background. Epstein-Barr virus (EBV) infection and posttransplant lymphoproliferative disorders (PTLDs) after pediatric liver transplantation (LT) account for significant morbidity and mortality. Knowledge of EBV kinetics, epidemiology, and outcomes among pediatric living-donor LT cases is largely lacking. This study aims to provide clinical information related to EBV infection, chronic high EBV load (CHL) carriage, and PTLD at a living-donor–dominant pediatric LT center. Methods. A total of 5827 EBV load measurements from 394 LT recipients fulfilling inclusion criteria and their clinical data were analyzed. EBV loads >1000 copies/μg DNA (742 IU/μg DNA) were considered “high,” and CHL was defined by persistence >6 mo. Results. The highlighted results were as follows: (1) 94% of recipients underwent living-donor LT; (2) 80% of EBV seronegative recipients developed first EBV infection <2 y post-LT, and their EBV loads were consistently higher than those of seropositive recipients within <3 y post-LT but did not differ thereafter; (3) 61 (15%) recipients met CHL criteria, but none developed PTLD; (4) age <5 y, cytomegalovirus seronegative donors, and early development of EBV DNAemia <6 mo post-LT were independent risk factors for CHL; (5) the incidence of rejections after 1-y post-LT was comparably low among CHL carriers whose immunosuppression was minimized. Conclusions. Early detection of EBV following LT and CMV seronegative donors would facilitate risk stratification to prevent PTLD while titrating immunosuppression among pediatric LT recipients.
影响因子：
20.3
作者：
Kanakry, Jennifer A.;Hegde, Aparna M.;Valsamakis, Alexandra
通讯作者：
Valsamakis, Alexandra