Impact of Immunosuppression on the Development of Epstein-Barr Virus (EBV) Viremia After Pediatric Liver Transplantation
Impact of Immunosuppression on the Development of Epstein-Barr Virus (EBV) Viremia After Pediatric Liver Transplantation
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DOI：
10.1016/j.transproceed.2012.04.035
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发表时间：
2013-01-01
影响因子：
0.9
通讯作者：
Berquist, W. E.
中科院分区：
文献类型：
--
作者：
Lu, B. R.;Park, K. T.;Berquist, W. E.
目标。儿科肝移植(OLT)患者面临着来自EB病毒(EBV)的移植后淋巴增生性疾病(PTLD)的风险。本研究检测了诱导和免疫抑制对EBV病毒的影响。对197例儿科患者进行了回顾，记录了移植后1年的诱导方案、免疫抑制水平和EBV病毒血症。Logistic回归模型确定了诱导、免疫抑制和EBV之间的关系。56%的患者出现EBV病毒血症。抗胸腺细胞球蛋白治疗EBV病毒血症的发生率为73%，Daclizumab为63%，两者均为39%，尽管趋势不显著[抗胸腺细胞球蛋白：优势比(OR)0.19；95%可信区间(CI)0.024-1.58；P=.125；Daclizumab OR；1.07；95%CI 0.270-4.23；P=.925]。他克莫司的免疫抑制水平超过治疗后28.7%；然而，只有在0到2周的他克莫司水平增加了移植后2到4周的EBV病毒血症(OR 1.80；95%CI 1.10~2.94；P=0.02)。3例患者发生PTLD。ATG和Daclizumab诱导的使用可能在EBV病毒血症的发生中不起作用。OLT术后0-2周的超治疗他克莫司水平影响2-4周的EBV病毒血症的发展。PTLD的发生率较低，提示更好的EBV和免疫抑制监测对减少PTLD具有重要作用。
Objectives. Pediatric liver transplant (OLT) patients are at risk of posttransplant lymphoproliferative disease (PTLD) from Epstein-Ban virus (EBV). This study examined the impact of induction and immunosuppression on EBV viremia.Methods. A retrospective chart review was performed on 197 pediatric patients and induction regimen, immunosuppression levels, and EBV viremia were documented for 1 year post-OLT. Logistic regression models determined associations between induction, immunosuppression, and EBV.Results. Fifty six percent of patients developed EBV viremia. Incidence of EBV viremia was 73% with antithymocyte globulin (ATG), 63% with daclizumab, and 39% for neither, though the trend was not significant [ATG: odds ratio (OR) 0.19; 95% confidence interval (CI) 0.024-1.58; P = .125; daclizumab OR; 1.07; 95% CI 0.270-4.23; P = .925]. Tacrolimus immunosuppression levels were supratherapeutic 28.7% of the time; however, only supratherapeutic tacrolimus levels between 0 and 2 weeks increased EBV viremia at 2 to 4 weeks post-OLT (OR 1.80; 95% CI 1.10-2.94; P = .02). Three patients developed PTLD.Conclusions. The use of ATG and daclizumab induction likely does not play a role in the development of EBV viremia. Supratherapeutic tacrolimus levels 0 to 2 weeks post-OLT impact the development of EBV viremia at 2 to 4 weeks. The incidence of PTLD was low, suggesting better EBV and immunosuppression monitoring plays an important role in reducing PTLD.