Epstein-Barr virus infection after pediatric living-related liver transplantation--management and risk factors.

INTRODUCTION

Posttransplant lymphoproliferative disorder (PTLD) is one of the severe complications after pediatric liver transplantation. Epstein-Barr virus (EBV) infection is a major risk factor developing PTLD. This study evaluates the risk factors, incidence, and clinical presentation of EBV infection at our institute.

PATIENTS AND METHODS

This study examines 81 children who underwent living-related liver transplantation (LRLT) from November 2005 to December 2009. The immunosuppression protocol consisted of tacrolimus and low-dose steroids, which were withdrawn by 3 months after LRLT. Additional immunosuppression was indicated for the selected cases because of recurrent rejection or renal insufficiency. Fifteen ABO blood type incompatible LRLTs were enrolled into this study. EBV was periodically monitored by the use of a real-time quantitative polymerase chain reaction (cut-off value, >10(2) copies/μg DNA). The median follow-up period was 637 days (range, 85 to 1548 days). These patients were divided into two groups: EBV infection versus EBV noninfection, for analysis of risk factors by univariate analysis.

RESULTS

The incidence of EBV infection was 50.6% (n = 41) with the mean onset of 276 ± 279 postoperative days (range, 7 to 1229 days). Nine cases (22.5%) presented clinical symptoms related to EBV infection, consisting of adenoid hypertrophy (n = 5), Evans's syndrome (n = 2), hemophagocytic syndrome (n = 1), and erythema nodosum (n = 1). There was no case of PTLD. The combination of a preoperative EBV seropositive donor and an EBV seronegative recipient was a high risk factor for postoperative EBV infection among the recipients (56.1% versus 26.8%, P < .05). The mean age at operation among the EBV infection group was younger than that of the EBV noninfection group (22 ± 30 months versus 62 ± 68 months; P < .05). The incidence of acute rejection episodes and cytomegalovirus infections; ABO blood type incompatible LRLT, and the length of steroid treatment and the additional immunosuppression were not significantly different between the two groups.

CONCLUSION

There were various clinical presentations related to EBV infection; however, none of our patients developed PTLD. Careful monitoring of EBV infection especially for cases with donor seropositivity is important to prevent disease progression.