Kamei Hideya, Ito Yoshinori, Kawada Junichi, Ogiso Satoshi, Onishi Yasuharu, Komagome Masahiko, Kurata Nobuhiko, Ogura Yasuhiro
Departments of Transplantation Surgery, Nagoya University Hospital, Showa, Nagoya, Japan.
Department of Pediatrics, Nagoya University Graduate School of Medicine, Showa, Nagoya, Japan.
Transpl Infect Dis. 2018 Aug;20(4):e12911. doi: 10.1111/tid.12911. Epub 2018 May 7.
Serial monitoring of Epstein-Barr virus (EBV) reveals that certain pediatric liver transplant (LT) recipients exhibit high EBV loads for long periods. We investigated the incidence and risk factors of chronic high EBV (CHEBV) loads (continuous EBV DNA >10 000 IU/mL of whole blood for ≥6 months) and long-term outcomes.
This single center, retrospective observational study investigated pediatric LT recipients who survived ≥6 months. We quantitated EBV DNA weekly during hospitalization and subsequently every 4 or 6 weeks at the outpatient clinic. Tacrolimus was maintained at a low trough level (<3 ng/mL, EBV DNA load >5000 IU/mL).
Thirty-one of 77 LT recipients developed CHEBV. Univariate analysis revealed that age <2 years and body weight <10 kg upon LT, operation time <700 minutes, warm ischemia time (WIT) >35 minutes, graft-to-recipient weight ratio (GRWR) >2.7%, and preoperative EBV seronegativity were significantly associated with the development of CHEBV loads. Multivariate analysis identified significant associations of CHEBV with WIT >35 minutes, GRWR >2.7%, and preoperative seronegative. None of the recipients developed post-transplantation lymphoproliferative disorder. Survival rates of patients with and without CHEBV loads were not significantly different.
A significant number of pediatric LT recipients developed CHEBV loads. Long WIT, high GRWR, and preoperative EBV seronegativity were significantly associated with the development of CHEBV loads. Although the long-term outcomes of patients with or without CHEBV loads were not significantly different, further studies of more subjects are warranted.
对爱泼斯坦-巴尔病毒（EBV）的系列监测显示，某些小儿肝移植（LT）受者长期呈现高EBV载量。我们调查了慢性高EBV（CHEBV）载量（全血中EBV DNA持续>10000 IU/mL达≥6个月）的发生率、危险因素及长期预后。
这项单中心回顾性观察性研究调查了存活≥6个月的小儿LT受者。住院期间每周对EBV DNA进行定量检测，随后在门诊每4或6周检测一次。将他克莫司维持在低谷浓度水平（<3 ng/mL，EBV DNA载量>5000 IU/mL）。
77例LT受者中有31例发生CHEBV。单因素分析显示，LT时年龄<2岁、体重<10 kg、手术时间<700分钟、热缺血时间（WIT）>35分钟、移植物与受者体重比（GRWR）>2.7%以及术前EBV血清学阴性与CHEBV载量的发生显著相关。多因素分析确定CHEBV与WIT>35分钟、GRWR>2.7%以及术前血清学阴性显著相关。所有受者均未发生移植后淋巴组织增生性疾病。有和无CHEBV载量患者的生存率无显著差异。
相当数量的小儿LT受者出现CHEBV载量。长WIT、高GRWR和术前EBV血清学阴性与CHEBV载量的发生显著相关。尽管有或无CHEBV载量患者的长期预后无显著差异，但仍需对更多受试者进行进一步研究。
