Department of Transplantation Surgery, Nagoya University Hospital, Nagoya, Japan.
Department of Transplantation and Endocrine Surgery (Surgery II), Nagoya University Graduate School of Medicine, Nagoya, Japan.
Transpl Infect Dis. 2021 Oct;23(5):e13731. doi: 10.1111/tid.13731. Epub 2021 Sep 22.
Chronic high Epstein-Barr virus loads (CHEBV) are commonly observed in pediatric liver transplant patients. However, it is unclear how CHEBV impacts the liver graft. The aim of this study was to clarify the clinical and pathological impacts of CHEBV on the liver graft.
From 2012 to 2020, we retrospectively investigated 46 pediatric liver transplant patients (under 16 years) who survived ≥6 months. The patients were divided into two groups: CHEBV group (EBV DNA >10 000 IU/ml of whole blood for ≥6 months) and nonchronic high EBV (NCHEBV) group (patients who did not meet CHEBV criteria). Tacrolimus was reduced to <3.0 ng/ml in patients with EBV DNA >5000 IU/ml. Blood biochemistry data and pathological findings, obtained at the time of protocol and episodic biopsies, were compared between the two groups.
Out of 46 patients, 28 CHEBV and 18 NCHEBV patients were enrolled. The blood biochemical examination did not show a significant difference between the two groups. In addition, no significant differences between the two groups were found in the pathological findings, including frequency of late acute rejection and the progression of fibrosis at the time of both protocol and episodic biopsies. Appropriate adjustment of immunosuppression for CHEBV management may have contributed to the prevention of the progression of fibrosis.
CHEBV had little adverse effect on the liver graft. Graft fibrosis might have been avoided through optimal dose modification of tacrolimus. Further long-term monitoring is necessary because CHEBV may affect the pediatric liver graft in the long term.
慢性高 Epstein-Barr 病毒载量（CHEBV）在儿科肝移植患者中很常见。然而，CHEBV 如何影响肝移植物尚不清楚。本研究旨在阐明 CHEBV 对肝移植物的临床和病理影响。
2012 年至 2020 年，我们回顾性调查了 46 例存活时间≥6 个月的儿科肝移植患者（年龄<16 岁）。患者分为两组：CHEBV 组（全血 EBV DNA >10000 IU/ml 持续≥6 个月）和非慢性高 EBV（NCHEBV）组（不符合 CHEBV 标准的患者）。对于 EBV DNA>5000 IU/ml 的患者，将他克莫司减少至<3.0ng/ml。比较两组患者在方案和偶发性肝活检时的血液生化数据和病理发现。
46 例患者中，28 例 CHEBV 和 18 例 NCHEBV 患者入选。两组间血液生化检查无显著差异。此外，两组患者在病理发现方面也无显著差异，包括方案和偶发性肝活检时晚期急性排斥反应的频率和纤维化进展。适当调整免疫抑制治疗 CHEBV 管理可能有助于预防纤维化进展。
CHEBV 对肝移植物影响不大。通过适当调整他克莫司剂量可能避免了移植物纤维化。由于 CHEBV 可能会对儿童肝移植物产生长期影响，因此需要进一步进行长期监测。
