Harwood J S, Gould F K, McMaster A, Hamilton J R, Corris P A, Hasan A, Gennery A R, Dark J H
Department of Microbiology, Freeman Hospital, Newcastle upon Tyne, UK.
Pediatr Transplant. 1999 May;3(2):100-3. doi: 10.1034/j.1399-3046.1999.00019.x.
Epstein-Barr virus (EBV)-associated post-transplant lymphoproliferative disease (PTLD) is a serious complication of organ and bone marrow transplantation. The importance of EBV matching between recipient and donor remains unclear. Between October 1987 and December 1997, 64 pediatric cardio-pulmonary transplants were performed at this center (58 hearts, two heart/lungs, four sequential single lungs). The EBV viral capsid antigen (VCA) immunoglobulin G (IgG) status of both donor and recipient was determined at the time of transplant. Of 56 patients from whom paired sera was available for analysis, 27 (50%) were recipient and donor EBV IgG positive, four (7%) were recipient EBV IgG positive and donor EBV IgG negative, and 12 (20%) were recipient EBV IgG negative and donor EBV IgG negative. The remaining 13 (23%) patients were EBV IgG negative but received organs from EBV IgG-positive donors. The EBV immunoglobulin M (IgM) status was determined from 6 weeks post-transplant in the 11 mismatches who survived for longer than 28 d. Seven became EBV IgM positive, two remained EBV IgM negative; the status of the remaining two remains unknown. The EBV IgM status was also determined retrospectively in patients who were EBV IgG negative pretransplant and received organs from EBV IgG-negative donors. Nine became EBV IgM positive; the rest remained negative. PTLD was diagnosed in two of 56 patients from whom paired sera was available; one was donor and recipient EBV IgG negative; the other was donor and recipient EBV IgG positive. No cases of PTLD were diagnosed in the remaining eight patients from whom paired sera was not available. Our experience suggests that PTLD does not occur with any greater frequency in the 'mismatch' group, and does not justify EBV matching in pediatric thoracic transplantation where there is a higher proportion of EBV-negative recipients than in adults.
爱泼斯坦-巴尔病毒（EBV）相关的移植后淋巴组织增生性疾病（PTLD）是器官和骨髓移植的一种严重并发症。受体与供体之间EBV配型的重要性仍不明确。1987年10月至1997年12月期间，该中心进行了64例小儿心肺移植手术（58例心脏移植、2例心肺联合移植、4例序贯单肺移植）。在移植时测定了供体和受体的EBV病毒衣壳抗原（VCA）免疫球蛋白G（IgG）状态。在56例有配对血清可供分析的患者中，27例（50%）受体和供体EBV IgG阳性，4例（7%）受体EBV IgG阳性而供体EBV IgG阴性，12例（20%）受体EBV IgG阴性且供体EBV IgG阴性。其余13例（23%）患者EBV IgG阴性，但接受了来自EBV IgG阳性供体的器官。对11例存活超过28天的不匹配患者，在移植后6周测定了EBV免疫球蛋白M（IgM）状态。7例变为EBV IgM阳性，2例仍为EBV IgM阴性；其余2例状态未知。对移植前EBV IgG阴性且接受来自EBV IgG阴性供体器官的患者也进行了回顾性EBV IgM状态测定。9例变为EBV IgM阳性；其余仍为阴性。在56例有配对血清可供分析的患者中，2例被诊断为PTLD；1例受体和供体EBV IgG阴性；另1例受体和供体EBV IgG阳性。在其余8例无配对血清可供分析的患者中未诊断出PTLD病例。我们的经验表明，“不匹配”组中PTLD的发生率并不更高，在小儿胸段移植中，EBV阴性受体比例高于成人，因此EBV配型并无必要。
