Department of Pediatrics, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang, South Korea.
Department of Pediatric, University of Ulsan College of Medicine, Asan Medical Center Children's Hospital, Seoul, South Korea.
Pediatr Transplant. 2020 Jun;24(4):e13666. doi: 10.1111/petr.13666. Epub 2020 Feb 17.
This study aimed to investigate the incidence of PTLD in pediatric liver transplant recipients and the risk factors for the development of PTLD. We also determined clinically useful quantitative EBV PCR parameters for aiding in the diagnosis of EBV-associated PTLD in the pediatric liver transplant recipients at our institute. We reviewed children < 18 years old who had undergone liver transplantations and quantitative analysis of whole blood EBV load at our institute from January 2006 to March 2015. A total of 142 liver transplant recipients were included, and their median age was 1.5 years. Clinically significant high-level EBV DNAemia ≥ 10 000 copies/mL at least twice was observed in 53.5% and PTLD occurred in 9.9%. Among PTLD group, graft failure and mortality rate were as high as 21.4% and 14.3%, respectively. Deceased donor, presence of high-level EBV DNAemia, and primary CMV infection following transplant were associated with an increased risk for PTLD in the multivariate analysis. The peak titer at 10 875 copies/mL could be used as a cutoff value with a sensitivity of 92.9% and a specificity of 37.9%; the rate of increase in EBV load suggested a sensitivity of 64.3% and a specificity of 70.9% at the cutoff value of 44 000 copies/mL/week. In conclusion, the incidence of PTLD following liver transplant in children was as high as 10%. PTLD is associated with significant morbidity and mortality. Close monitoring of EBV DNAemia is crucial for the early diagnosis and proper treatment of PTLD in pediatric liver transplant recipients.
本研究旨在调查小儿肝移植受者中 PTLD 的发生率和 PTLD 发展的危险因素。我们还确定了在我院接受肝移植的小儿患者中，用于协助 EBV 相关性 PTLD 诊断的具有临床意义的 EBV-PCR 参数。我们回顾性分析了 2006 年 1 月至 2015 年 3 月期间在我院接受肝移植且进行了全血 EBV 载量定量分析的<18 岁儿童。共纳入 142 例肝移植受者，中位年龄为 1.5 岁。53.5%的患者至少两次观察到有临床意义的高水平 EBV DNAemia（≥10000 拷贝/ml），9.9%的患者发生了 PTLD。在 PTLD 组中，移植物失功和死亡率分别高达 21.4%和 14.3%。多变量分析显示，死亡供者、高水平 EBV DNAemia 存在和移植后原发性 CMV 感染与 PTLD 风险增加相关。10875 拷贝/ml 的峰值滴度可作为截断值，其敏感性为 92.9%，特异性为 37.9%；在 EBV 载量增加的截断值为 44000 拷贝/ml/周时，其敏感性为 64.3%，特异性为 70.9%。总之，小儿肝移植后发生 PTLD 的发生率高达 10%。PTLD 与较高的发病率和死亡率相关。密切监测 EBV DNAemia 对于早期诊断和适当治疗小儿肝移植受者的 PTLD 至关重要。
