1. Epstein-Barr viral loads do not predict post-transplant lymphoproliferative disorder in pediatric lung transplant recipients: A multicenter prospective cohort study
- Author
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Andrew, Parrish, Matthew, Fenchel, Gregory A, Storch, Richard, Buller, Sheila, Mason, Nikki, Williams, David, Ikle, Carol, Conrad, Albert, Faro, Samuel, Goldfarb, Don, Hayes, Ernestina, Melicoff-Portillo, Marc, Schecter, Gary, Visner, Stuart, Sweet, Lara, Danziger-Isakov, and Mea, Ebenbichler
- Subjects
Male ,Epstein-Barr Virus Infections ,Herpesvirus 4, Human ,medicine.medical_specialty ,Adolescent ,medicine.medical_treatment ,030232 urology & nephrology ,Lymphoproliferative disorders ,Kaplan-Meier Estimate ,030230 surgery ,medicine.disease_cause ,Polymerase Chain Reaction ,Gastroenterology ,Article ,Post-transplant lymphoproliferative disorder ,Organ transplantation ,Young Adult ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,Risk Factors ,hemic and lymphatic diseases ,Internal medicine ,medicine ,Humans ,Lung transplantation ,Prospective Studies ,Child ,Prospective cohort study ,Transplantation ,medicine.diagnostic_test ,business.industry ,Infant ,Viral Load ,medicine.disease ,Epstein–Barr virus ,Lymphoproliferative Disorders ,surgical procedures, operative ,Bronchoalveolar lavage ,Child, Preschool ,DNA, Viral ,Pediatrics, Perinatology and Child Health ,Immunology ,Female ,business ,Bronchoalveolar Lavage Fluid ,Viral load ,Lung Transplantation - Abstract
Prediction of PTLD after pediatric lung transplant remains difficult. Use of EBV VL in WB has been poorly predictive, while measurement of VL in BAL fluid has been suggested to have enhanced utility. The NIH-sponsored Clinical Trials in Organ Transplantation in Children (CTOTC-03) prospectively obtained serial quantitative measurements of EBV PCR in both WB and BAL fluid after pediatric lung transplantation. Descriptive statistics, contingency analyses, and Kaplan-Meier analyses evaluated possible association between EBV and PTLD. Of 61 patients, 34 (56%) had an EBV+PCR (at least once in WB or BAL). EBV donor (D)+patients more often had a positive PCR (D+/recipient (R)-: 13/18; D+/R+: 14/23) compared to EBV D- patients (6/17). Several D-/R- (5/12) patients developed EBV, but none developed PTLD. All four PTLD patients were D+/R- with EBV+PCR. Neither the time to first EBV+PCR nor the CT for PCR positivity in BAL or WB was statistically different between those with and without PTLD. Having an EBV-seropositive donor was associated with increased risk of EBV+PCR in WB. EBV load in BAL was not predictive of PTLD.
- Published
- 2017