ESPN 51th Annual Meeting

ESPN 2018


 
Chronic high Epstein-Barr viral load carriage in pediatric kidney transplant patients
SUSANNE WESTPHAL LADFORS 1 JENNY LINDAHL 2 SVERKER HANSSON 1 VANDA FRIMAN 2

1- PEDIATRIC URONEPHROLOGIC CENTER, THE QUEEN SILVIA CHILDREN´S HOSPITAL, SAHLGRENSKA ACADEMY, UNIVERSITY OF GOTHENBURG, SWEDEN
2- INSTITUTION OF INFECTIOUS DISEASES, SAHLGRENSKA ACADEMY, UNIVERSITY OF GOTHENBURG, SWEDEN
 
Introduction:

Epstein-Barr virus (EBV) infection is of particular interest in transplanted patients because of the association with post-transplant lymphoproliferative disorder (PTLD). In this study the natural history of EBV infection is described and its possible evolution toward PTLD in a cohort of 58 pediatric renal transplant recipients

Material and methods:

58 children underwent renal transplantation at an age of 1-17 years (median 10 years) at Queen Silvia Children´s hospital in Gothenburg, Sweden between 2004 and 2017. Immunosuppression included tacrolimus, mycophenolate mofetil (MMF), steroids and after 2010 induction with two doses of basiliximab. The serostatus of EBV was analysed before transplantation and yearly thereafter. Analyses of EBV DNA using PCR were performed every week during the first three months post-transplant, once monthly up to one year and thereafter according to PCR status. Chronic high Epstein-Barr viral load carriage (CHL) was defined as the presence of EBV PCR DNA ≥4.2 log for >50% of the samples for >6 months.

Results:

At transplantation 31 patients (53%) patients were EBV seronegative. Following transplantation, 25 of the 31 seronegative patients (80%) developed a primary EBV infection based on the results of PCR assays for EBV DNA. Among the 27 seropositive patients 20 (74%) presented a reactivation of EBV. Fourteen children (24%) became CHL EBV carriers after a median of 69 days post-transplant. The clinical presentation was non-specific or asymptomatic. The immunosuppression was carefully evaluated and reduced in CHL carriers. The CHL group was younger at transplantation (median 2 years), they had more often living donors and they had fewer rejections despite reduced immunosuppression. None of the children developed PTLD during the follow-up of median 8.4 years (0.7-13 years).

Conclusions:

CHL carriage occurred frequently (24%) but no child developed PTLD, possibly because of careful follow-up and reduced immunosuppression in CHL patients.