Roles of Epstein–Barr virus viral load monitoring in the prediction of posttransplant lymphoproliferative disorder in pediatric liver transplantation
Background/Purpose: This study is aimed to investigate the risk factors and clinical characteristics of posttransplant lymphoproliferative disorder (PTLD) after conducting Epstein–Barr virus (EBV) viral load monitoring in pediatric liver transplant (LT) patients in Taiwan, where EBV infection is end...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2019-09-01
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| Series: | Journal of the Formosan Medical Association |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S0929664618302390 |
| _version_ | 1818412816638410752 |
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| author | Ho-Sheng Chen Ming-Chih Ho Rey-Heng Hu Jia-Feng Wu Huey-Ling Chen Yen-Hsuan Ni Hong-Yuan Hsu Yung-Ming Jeng Mei-Hwei Chang |
| author_facet | Ho-Sheng Chen Ming-Chih Ho Rey-Heng Hu Jia-Feng Wu Huey-Ling Chen Yen-Hsuan Ni Hong-Yuan Hsu Yung-Ming Jeng Mei-Hwei Chang |
| author_sort | Ho-Sheng Chen |
| collection | DOAJ |
| description | Background/Purpose: This study is aimed to investigate the risk factors and clinical characteristics of posttransplant lymphoproliferative disorder (PTLD) after conducting Epstein–Barr virus (EBV) viral load monitoring in pediatric liver transplant (LT) patients in Taiwan, where EBV infection is endemic. Methods: From 2007 to 2013, pediatric LT recipients who underwent EBV viral load monitoring within 3 months after LT were recruited in this study. The impact of clinical parameters—including age at LT, sex, peak EBV viral load and immunosuppressant levels after LT—on the risk of PTLD were assessed. Results: A total 39 patients underwent LT at a median age of 1.3 years (range: 0.6–14.0 years), and 5 patients developed PTLD during follow-up. Cox's proportional-hazards model identified two predictors of PTLD: peak EBV viral load within 3 months of LT >4100 copies/μg peripheral blood mononuclear cells (PBMC) DNA and peak tacrolimus level within 3 months of LT >14.8 ng/mL (Hazard ratio = 17.14 and 11.54, P = 0.02 and 0.03, respectively). Kaplan–Meier survival analysis revealed significant higher cumulative incidence rates of PTLD (27.3% and 41.8% at 0.3 and 1.2 years after LT) in subjects with peak EBV viral load >4100 copies/μg PBMC DNA within 3 months after LT. (P = 0.001, log-rank test). Conclusion: Close monitoring of EBV viral load within 3 months after LT is helpful to predict a high risk of PTLD. Tapering of immunosuppressants is suggested if the EBV viral load is >4100 copies/μg PBMC DNA in LT children. Keywords: Epstein–Barr virus infections, Liver transplantation, Lymphoproliferative disorders, Pediatrics, Viral load |
| first_indexed | 2024-12-14T10:53:19Z |
| format | Article |
| id | doaj.art-45c4b568513b4425a9f7965fd750734d |
| institution | Directory Open Access Journal |
| issn | 0929-6646 |
| language | English |
| last_indexed | 2024-12-14T10:53:19Z |
| publishDate | 2019-09-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of the Formosan Medical Association |
| spelling | doaj.art-45c4b568513b4425a9f7965fd750734d2022-12-21T23:05:04ZengElsevierJournal of the Formosan Medical Association0929-66462019-09-01118913621368Roles of Epstein–Barr virus viral load monitoring in the prediction of posttransplant lymphoproliferative disorder in pediatric liver transplantationHo-Sheng Chen0Ming-Chih Ho1Rey-Heng Hu2Jia-Feng Wu3Huey-Ling Chen4Yen-Hsuan Ni5Hong-Yuan Hsu6Yung-Ming Jeng7Mei-Hwei Chang8Department of Pediatrics, National Taiwan University Hospital Hsin-Chu Branch, TaiwanDepartment of Surgery, National Taiwan University Hospital, National Taiwan University, Taipei, TaiwanDepartment of Surgery, National Taiwan University Hospital, National Taiwan University, Taipei, TaiwanDepartment of Pediatrics, National Taiwan University Hospital, National Taiwan University, Taipei, TaiwanDepartment of Pediatrics, National Taiwan University Hospital, National Taiwan University, Taipei, TaiwanDepartment of Pediatrics, National Taiwan University Hospital, National Taiwan University, Taipei, TaiwanDepartment of Pediatrics, National Taiwan University Hospital, National Taiwan University, Taipei, TaiwanDepartment of Pathology, National Taiwan University Hospital, National Taiwan University, Taipei, TaiwanDepartment of Pediatrics, National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan; Corresponding author. Department of Pediatrics, National Taiwan University Hospital, No. 8, Chung-Shan S. Rd., Taipei, Taiwan. Fax: +886 2 23114592.Background/Purpose: This study is aimed to investigate the risk factors and clinical characteristics of posttransplant lymphoproliferative disorder (PTLD) after conducting Epstein–Barr virus (EBV) viral load monitoring in pediatric liver transplant (LT) patients in Taiwan, where EBV infection is endemic. Methods: From 2007 to 2013, pediatric LT recipients who underwent EBV viral load monitoring within 3 months after LT were recruited in this study. The impact of clinical parameters—including age at LT, sex, peak EBV viral load and immunosuppressant levels after LT—on the risk of PTLD were assessed. Results: A total 39 patients underwent LT at a median age of 1.3 years (range: 0.6–14.0 years), and 5 patients developed PTLD during follow-up. Cox's proportional-hazards model identified two predictors of PTLD: peak EBV viral load within 3 months of LT >4100 copies/μg peripheral blood mononuclear cells (PBMC) DNA and peak tacrolimus level within 3 months of LT >14.8 ng/mL (Hazard ratio = 17.14 and 11.54, P = 0.02 and 0.03, respectively). Kaplan–Meier survival analysis revealed significant higher cumulative incidence rates of PTLD (27.3% and 41.8% at 0.3 and 1.2 years after LT) in subjects with peak EBV viral load >4100 copies/μg PBMC DNA within 3 months after LT. (P = 0.001, log-rank test). Conclusion: Close monitoring of EBV viral load within 3 months after LT is helpful to predict a high risk of PTLD. Tapering of immunosuppressants is suggested if the EBV viral load is >4100 copies/μg PBMC DNA in LT children. Keywords: Epstein–Barr virus infections, Liver transplantation, Lymphoproliferative disorders, Pediatrics, Viral loadhttp://www.sciencedirect.com/science/article/pii/S0929664618302390 |
| spellingShingle | Ho-Sheng Chen Ming-Chih Ho Rey-Heng Hu Jia-Feng Wu Huey-Ling Chen Yen-Hsuan Ni Hong-Yuan Hsu Yung-Ming Jeng Mei-Hwei Chang Roles of Epstein–Barr virus viral load monitoring in the prediction of posttransplant lymphoproliferative disorder in pediatric liver transplantation Journal of the Formosan Medical Association |
| title | Roles of Epstein–Barr virus viral load monitoring in the prediction of posttransplant lymphoproliferative disorder in pediatric liver transplantation |
| title_full | Roles of Epstein–Barr virus viral load monitoring in the prediction of posttransplant lymphoproliferative disorder in pediatric liver transplantation |
| title_fullStr | Roles of Epstein–Barr virus viral load monitoring in the prediction of posttransplant lymphoproliferative disorder in pediatric liver transplantation |
| title_full_unstemmed | Roles of Epstein–Barr virus viral load monitoring in the prediction of posttransplant lymphoproliferative disorder in pediatric liver transplantation |
| title_short | Roles of Epstein–Barr virus viral load monitoring in the prediction of posttransplant lymphoproliferative disorder in pediatric liver transplantation |
| title_sort | roles of epstein barr virus viral load monitoring in the prediction of posttransplant lymphoproliferative disorder in pediatric liver transplantation |
| url | http://www.sciencedirect.com/science/article/pii/S0929664618302390 |
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