D'Antiga Lorenzo, Del Rizzo Monica, Mengoli Carlo, Cillo Umberto, Guariso Graziella, Zancan Lucia
Department of Paediatrics, University of Padua, Italy.
Liver Transpl. 2007 Mar;13(3):343-8. doi: 10.1002/lt.20958.
Epstein-Barr virus (EBV) infection is the main cause of post-transplant lymphoproliferative disease (PTLD). Little is known on chronic carrier state and its relation with late PTLD. We aimed to study EBV infection in the long-term after paediatric liver transplantation (OLT). We conducted a retrospective review of 34 children monitored for a median of 5.8 years (range 1.5-17.7). 21 were IgG seronegative (group A) and 13 seropositive (group B) before OLT. Primary infection was the appearance of VCA-IgM or VCA-IgG or Real-Time Polymerase Chain Reaction (RT-PCR) in patients previously IgG seronegative; positive VCA-IgM or EA-IgG or RT-PCR lasting longer than 6 months was defined sustained viral detection (SVD). 18/21 patients of group A had a primary infection at a median time of 3 months after transplant (0.5-60). 14/18 of group A and 0/13 of group B had a SVD (P < 0.0001). Viral loads greater than 500 copies/10(5) mononuclear cells occurred in 12/18 patients in group A and 0/13 patients in group B (P < 0.0001). The 3 patients who developed late PTLD (median time after OLT 47 months, range 15-121) were from group A, and presented with SVD before developing PTLD. In conclusion, EBV infection in seronegative patients at OLT is associated with greater viral loads and sustained viral detection. Late PTLD occurred only in naïve patients with markers of SVD. Three to 4 monthly long-term monitoring of EBV in pre-OLT naïve patients might help preventing the occurrence of late PTLD.
爱泼斯坦-巴尔病毒（EBV）感染是移植后淋巴细胞增生性疾病（PTLD）的主要病因。关于慢性携带状态及其与晚期PTLD的关系，人们了解甚少。我们旨在研究小儿肝移植（OLT）术后长期的EBV感染情况。我们对34名儿童进行了回顾性研究，这些儿童的中位监测时间为5.8年（范围1.5 - 17.7年）。OLT术前，21名儿童IgG血清学阴性（A组），13名儿童血清学阳性（B组）。原发性感染定义为既往IgG血清学阴性的患者出现VCA-IgM或VCA-IgG或实时聚合酶链反应（RT-PCR）阳性；VCA-IgM或EA-IgG或RT-PCR阳性持续超过6个月定义为持续性病毒检测（SVD）。A组21名患者中有18名在移植后中位时间3个月（0.5 - 60个月）出现原发性感染。A组18名患者中有14名、B组13名患者中0名出现SVD（P < 0.0001）。A组18名患者中有12名、B组13名患者中0名病毒载量大于500拷贝/10(5)个单核细胞（P < 0.0001）。发生晚期PTLD的3名患者（OLT术后中位时间47个月，范围15 - 121个月）均来自A组，且在发生PTLD之前出现SVD。总之，OLT时血清学阴性患者的EBV感染与更高的病毒载量和持续性病毒检测相关。晚期PTLD仅发生在有SVD标志物的未感染过EBV的患者中。对OLT术前未感染过EBV的患者进行每3至4个月的长期EBV监测可能有助于预防晚期PTLD的发生。
