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

Timothy C. Lee, Barbara Savoldo, Cliona M. Rooney, Helen Heslop, Adrian P. Gee, Yvette Caldwell, Neal R. Barshes, Jaymee D. Scott, Lisa J. Bristow, Christine A. O'Mahony, John A. Goss

Research output: Contribution to journalArticle

170 Scopus citations

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/μg 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.

Original languageEnglish (US)
Pages (from-to)2222-2228
Number of pages7
JournalAmerican Journal of Transplantation
Volume5
Issue number9
DOIs
StatePublished - Sep 2005

Keywords

  • Epstein-Barr virus (EBV)
  • Liver transplantation
  • Pediatric
  • Post-transplant lymphoproliferative disorder (PTLD)

ASJC Scopus subject areas

  • Immunology

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