Ozçay F, Arslan H, Bilezikçi B, Sevmiş S, Moray G, Haberal M
Department of Pediatric Gastroenterology, Faculty of Medicine, Başkent University, Ankara, Turkey.
Transplant Proc. 2009 Sep;41(7):2878-80. doi: 10.1016/j.transproceed.2009.07.059.
Epstein-Barr virus (EBV) infection occurring in the postoperative period represents a significant risk for pediatric transplant recipients. It presents in various manners, including a mononucleosis-like syndrome, hepatitis, encephalopathy, or posttransplant lymphoproliferative disease (PTLD). Valacyclovir has in vitro activity against EBV. We sought to review our experience with valacyclovir on peripheral blood EBV viral loads among a group of EBV-infected patients after liver transplantation (OLT).
Twelve children of ages 6-36 months (median, 12 months), underwent OLT. Eight (66%) were EBV immunoglobulin (Ig)G seronegative at the time of the operation. Eight patients developed primary infection and 4 patients developed reactivation of a post primary infection. Valacyclovir was prescribed immediately to 3 patients when we detected an acute-primary EBV infection. Valacyclovir was prescribed for 2 patients who had primary EBV infections followed by PTLD. Three patients who had primary EBV infection were administered valacyclovir after they became chronically EBV PCR positive for more than 1 year. Four out of 12 cases (33%) were EBV seropositive at the time of OLT, and underwent postprimary EBV reactivation displaying chronic EBV carrier state for 8-10 months before valacyclovir treatment. Peripheral blood EBV viral loads were tested every 2 months. The primary outcome was the proportion of subjects with EBV viremia who had a >or=2 log 10 decrease in EBV copies/mL after valacyclovir treatment. The duration of valacyclovir treatment was a median of 10 months (range, 8-11 months). At the beginning of the treatment period the median level of EBV viral load was 1.1 x 10(4) (range, 1 x 10(4) to 1 x 10(7)). EBV virus was cleared in only 1 patient with primary acute EBV infection. EBV viral loads did not change in 7 of 12 patients and decreased only 1 log 10 (n = 2) or 2 log 10 (n = 2).
In this small, non-placebo-controlled study, valacyclovir treatment was not effective to decrease peripheral blood EBV viral loads.
术后发生的爱泼斯坦-巴尔病毒（EBV）感染对小儿移植受者构成重大风险。其表现形式多样，包括类单核细胞增多症综合征、肝炎、脑病或移植后淋巴细胞增生性疾病（PTLD）。伐昔洛韦对EBV具有体外活性。我们试图回顾我们在一组肝移植（OLT）后EBV感染患者中使用伐昔洛韦对外周血EBV病毒载量的经验。
12名年龄在6至36个月（中位年龄12个月）的儿童接受了OLT。其中8名（66%）在手术时EBV免疫球蛋白（Ig）G血清学阴性。8名患者发生原发性感染，4名患者发生原发性感染后的再激活。当我们检测到急性原发性EBV感染时，立即给3名患者开了伐昔洛韦。给2名发生原发性EBV感染并随后发展为PTLD的患者开了伐昔洛韦。3名原发性EBV感染患者在其EBV PCR长期阳性超过1年后给予伐昔洛韦。12例中有4例（33%）在OLT时EBV血清学阳性，在伐昔洛韦治疗前经历原发性EBV再激活并表现为慢性EBV携带状态8至10个月。每2个月检测外周血EBV病毒载量。主要结局是伐昔洛韦治疗后EBV病毒血症患者中EBV拷贝数/mL下降≥2 log10的受试者比例。伐昔洛韦治疗的持续时间中位为10个月（范围8至11个月）。在治疗期开始时，EBV病毒载量的中位水平为1.1×10⁴（范围1×10⁴至1×10⁷）。仅1例原发性急性EBV感染患者的EBV病毒被清除。12例患者中有7例EBV病毒载量未改变，仅2例下降1 log10，2例下降2 log10。
在这项小型、非安慰剂对照研究中，伐昔洛韦治疗未能有效降低外周血EBV病毒载量。
