Serial measurement of Epstein-Barr viral load in peripheral blood in pediatric liver transplant recipients during treatment for posttransplant lymphoproliferative disease
Serial measurement of Epstein-Barr viral load in peripheral blood in pediatric liver transplant recipients during treatment for posttransplant lymphoproliferative disease
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DOI：
10.1097/00007890-199812270-00012
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发表时间：
1998-12-27
期刊：
影响因子：
6.2
通讯作者：
Reyes, J
中科院分区：
文献类型：
--
作者：
Green, M;Cacciarelli, TV;Reyes, J
背景。很少有数据描述EBV相关移植后淋巴细胞增生性疾病（PTLD）诊断后eb病毒（EBV）病毒载量的自然史。因此，我们前瞻性地跟踪了7例小儿原位肝移植受者在诊断为EBV/PTLD后的EBV病毒载量。通过定量竞争聚合酶链反应连续检测小儿PTLD患者外周血EBV病毒载量，并与患儿临床病程进行相关性分析。病毒载量达到200个基因组拷贝/10(5)个外周血淋巴细胞被认为与PTLD风险增加相一致。病毒载量200被认为是病毒学“反弹”的证据。诊断为PTLD时的平均EBV病毒载量为1029。所有患者在PTLD治疗期间都“清除”了他们的EBV病毒载量；该系列患者和移植物的存活率为100%。从外周血清除EBV的平均时间（18.8天）与发生首次排斥反应的平均时间（13.8天）相似。在诊断出EBV/PTLD后排斥反应时，7例患者中有5例发现EBV病毒载量始终为200，中位时间为EBV/PTLD后3.5个月（范围为2.3-13个月）。然而，这些儿童没有任何证据表明PTLD复发。外周血中EBV病毒载量的清除似乎与宿主免疫反应的恢复有关，这可以通过PTLD的消退和排斥反应的发生来说明。EBV病毒载量的后期反弹是常见的，似乎不能预测疾病复发。
Background. Few data are available describing the natural history of the Epstein-Barr virus (EBV) viral load after the diagnosis of EBV-associated posttransplant lymphoproliferative disease (PTLD). Accordingly, we prospectively followed the EBV viral load after the diagnosis of EBV/PTLD in seven pediatric orthotopic liver transplant recipients.Methods. EBV viral loads were serially measured by quantitative competitive polymerase chain reaction of the peripheral blood from pediatric patients with PTLD and correlated with the clinical course of these children. Viral loads >200 genome copies/10(5) peripheral blood lymphocytes were considered consistent with an increased risk of PTLD. Viral loads 200 were considered evidence of virologic "rebound."Results. The mean EBV viral load at the time of diagnosis of PTLD was 1029. All patients "cleared" their EBV viral load during the treatment of PTLD; patient and graft survival in this series was 100%. The mean time to clearance of EBV from the peripheral blood (18.8 days) was similar to the mean time to onset of first rejection (13.8 days). EBV viral load at the time of diagnosis of rejection after PTLD was always 200 was noted in five of seven patients a median of 3.5 months (range 2.3-13 months) after the diagnosis of EBV/PTLD. How ever, none of these children has had any evidence of PTLD recurrence.Conclusions. Clearance of the EBV viral load from the peripheral blood seems to correlate with restoration of the host's immune response as noted both by the regression of the PTLD and the onset of rejection. Late rebound of the EBV viral load is common and does not seem to predict disease recurrence.