Yamada Masaki, Nguyen Christina, Fadakar Paul, Ganoza Armando, Humar Abhinav, Shapiro Ron, Michaels Marian G, Green Michael
Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA.
Pediatrics/Surgery and Thomas E. Starzl Transplantation Institute, University of Pittsburgh, Pittsburgh, PA, USA.
Pediatr Transplant. 2018 May;22(3):e13147. doi: 10.1111/petr.13147. Epub 2018 Feb 6.
The development of EBV infection and PTLD is normally associated with a high EBV viral load in peripheral blood. Observations have previously identified existence of a CHL carrier state that demonstrated variable outcomes based upon the organ which was transplanted. Data defining the incidence and outcome of CHL in pediatric KTx are not well described. The charts of children undergoing isolated KTx at Children's Hospital of Pittsburgh between January 2000 and December 2014 were retrospectively reviewed. EBV loads in the peripheral blood were routinely measured as part of surveillance protocols at our center. CHL was defined as the presence of high load for >50% of samples for ≥6 months. PTLD was defined histologically using WHO definitions. Of 188 isolated KTx recipients, we identified a total of 16 (8%) children who developed CHL carrier state. No patient developed EBV-driven late-onset PTLD. Age at the time of KTx was significantly lower in the CHL group (median 3.9 years, interquartile range: IQR 2.9-6.6, P = .0004). Children in the CHL group were more likely to be EBV-seronegative prior to KTx (94%, 15/16), compared to the UVL and LVL groups (55% and 50%, respectively, P < .002). The median duration of CHL carrier state was 20 months (IQR 10.7-35.8). Fifteen of the 16 CHL carriers experienced spontaneous resolution of CHL carrier state. Children in the CHL group were younger at the time of primary EBV infection (P = .023). Finally, antiviral medication was not effective in either preventing or decreasing the EBV viral load in blood (P = .84). Overall incidence of late-onset PTLD is very low compared to heart and intestinal transplant, even though KTx recipients can develop CHL carrier state. The CHL carriers in KTx recipients were EBV-seronegative prior to transplant and were younger both at the time of KTx and at the time of primary EBV infection compared to those in the UVL and HVL groups. Antivirals did not prevent EBV infection or decrease EBV viral loads.
EBV感染和移植后淋巴增殖性疾病（PTLD）的发生通常与外周血中高EBV病毒载量相关。此前的观察已确定存在一种CHL携带状态，其结果因移植器官的不同而有所差异。关于儿童肾移植（KTx）中CHL的发病率和转归的数据描述尚不充分。我们回顾性分析了2000年1月至2014年12月在匹兹堡儿童医院接受单纯KTx的儿童的病历。作为我们中心监测方案的一部分，常规检测外周血中的EBV载量。CHL定义为≥6个月内>50%的样本存在高病毒载量。PTLD根据世界卫生组织的定义进行组织学诊断。在188例单纯KTx受者中，我们共识别出16例（8%）发生CHL携带状态的儿童。无患者发生EBV驱动的迟发性PTLD。CHL组KTx时的年龄显著更低（中位数3.9岁，四分位间距：IQR 2.9 - 6.6，P = 0.0004）。与低病毒载量（UVL）组和高病毒载量（LVL）组相比，CHL组儿童在KTx前更可能为EBV血清阴性（分别为94%，15/16；UVL组和LVL组分别为55%和50%，P < 0.002）。CHL携带状态的中位持续时间为20个月（IQR 10.7 - 35.8）。16例CHL携带者中有15例CHL携带状态自发缓解。CHL组儿童初次EBV感染时年龄更小（P = 0.023）。最后，抗病毒药物在预防或降低血液中EBV病毒载量方面均无效（P = 0.84）。与心脏和肠道移植相比，迟发性PTLD的总体发病率非常低，尽管KTx受者可发生CHL携带状态。与UVL组和HVL组相比，KTx受者中的CHL携带者在移植前为EBV血清阴性，且在KTx时以及初次EBV感染时年龄更小。抗病毒药物不能预防EBV感染或降低EBV病毒载量。
