Tanaka Eriko, Sato Tetsuya, Ishihara Masayuki, Tsutsumi Yasushi, Hisano Masataka, Chikamoto Hiroko, Akioka Yuko, Dohno Sumitaka, Maeda Akihiko, Hattori Motoshi, Wakiguchi Hiroshi, Fujieda Mikiya
Department of Pediatric Nephrology, Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan.
Pediatr Transplant. 2011 May;15(3):306-13. doi: 10.1111/j.1399-3046.2010.01465.x.
High viral load carriage of EBV is one of the risks for PTLD in transplant recipients. We reviewed retrospectively in pediatric renal transplant recipients with EBV seronegative. EBV loads in peripheral blood and EBV-CTLs were measured every 1-3 months in 13 patients after grafting. Immunosuppressants were reduced when the patients were considered to have persistent high EBV loads (>1000 copies/μgDNA for over six months). All showed primary EBV infection: six with asymptomatic persistent high EBV loads (group A) and seven with neither EBV-associated symptoms nor persistent high EBV loads (group B). No patient developed PTLD in either group. Chronic rejection occurred in one patient in group A after immunosuppressants' reduction. There was no difference in renal dysfunction rates between the two groups. The maximum and increase rates in EBV loads were significantly higher in group A. The CTLs' percentage was significantly lower in group A when EBV loads first rose above 100 copies/μg DNA. This study suggests the possibility that EBV loads and CTLs' monitoring may be useful for avoidance of PTLD, as patients with asymptomatic persistent high EBV loads had higher EBV loads and lower percentages of CTLs.
EBV的高病毒载量携带是移植受者发生PTLD的风险之一。我们对EBV血清阴性的小儿肾移植受者进行了回顾性研究。对13例移植后的患者每1 - 3个月检测一次外周血中的EBV载量和EBV特异性细胞毒性T淋巴细胞（EBV-CTLs）。当患者被认为存在持续高EBV载量（>1000拷贝/μgDNA超过6个月）时，减少免疫抑制剂用量。所有患者均表现为原发性EBV感染：6例无症状且持续高EBV载量（A组），7例既无EBV相关症状也无持续高EBV载量（B组）。两组均无患者发生PTLD。A组1例患者在减少免疫抑制剂用量后发生慢性排斥反应。两组间肾功能不全发生率无差异。A组EBV载量的最大值和升高率显著更高。当EBV载量首次升至高于100拷贝/μg DNA时，A组的CTLs百分比显著更低。本研究提示，由于无症状持续高EBV载量的患者具有更高的EBV载量和更低的CTLs百分比，监测EBV载量和CTLs可能有助于避免PTLD。
