Østensen Anniken B, Sanengen Truls, Holter Ellen, Line Pål-Dag, Almaas Runar
Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway.
Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
Pediatr Transplant. 2017 Sep;21(6). doi: 10.1111/petr.13010. Epub 2017 Jun 26.
EBV after pediatric LT is a risk factor for PTLD. We wanted to evaluate the effect of intravenous ganciclovir on EBV viremia and to identify risk factors for chronic EBV viremia. All pediatric patients who underwent LT in Norway from 2002 until 2015 were reviewed. Twenty-two of 38 patients with viremia were treated with intravenous ganciclovir for a median of 22 (21-38) days. Treated and untreated patients were not different with respect to EBV seroconversion prior to transplantation or age at transplantation, but treated patients had significantly earlier viremia after transplantation (P=.005). There was no difference in the proportion of patients with reduction in virus load in patients treated with ganciclovir compared to untreated patients at 8 weeks. After 1 year, five of 19 patients treated with ganciclovir and six of 14 untreated patients had reduced virus load compared to start of viremia (P=.27). In conclusion, treatment with intravenous ganciclovir did not change the proportion of patients with reduction in EBV load at 8 weeks and 1 year after viremia. Younger age at transplantation, short time from transplantation to viremia, and lack of EBV seroconversion prior to transplantation were significant predictors of chronic EBV viremia.
小儿肝移植后感染EBV是发生移植后淋巴增殖性疾病（PTLD）的一个危险因素。我们想要评估静脉注射更昔洛韦对EBV病毒血症的影响，并确定慢性EBV病毒血症的危险因素。对2002年至2015年在挪威接受肝移植的所有小儿患者进行了回顾性研究。38例病毒血症患者中有22例接受了静脉注射更昔洛韦治疗，中位治疗时间为22（21 - 38）天。治疗组和未治疗组在移植前的EBV血清学转换或移植时的年龄方面没有差异，但治疗组在移植后病毒血症出现得明显更早（P = 0.005）。在8周时，接受更昔洛韦治疗的患者与未治疗的患者相比，病毒载量降低的患者比例没有差异。1年后，与病毒血症开始时相比，19例接受更昔洛韦治疗的患者中有5例以及14例未治疗的患者中有6例病毒载量降低（P = 0.27）。总之，静脉注射更昔洛韦治疗并没有改变病毒血症发生后8周和1年时EBV载量降低的患者比例。移植时年龄较小、从移植到出现病毒血症的时间较短以及移植前缺乏EBV血清学转换是慢性EBV病毒血症的重要预测因素。
