1. Impact of EBV infection and immune function assay for lymphoproliferative disorder in pediatric patients after liver transplantation: A single-center experience
- Author
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Yan Yan Song, Jian Xin Zheng, Feng Xue, Xiang Qian Gu, Jin Chuan Liu, Qiang Xia, Tian Qin, and Seogsong Jeong
- Subjects
Male ,medicine.medical_specialty ,Epstein-Barr Virus Infections ,Adolescent ,medicine.medical_treatment ,Liver transplantation ,medicine.disease_cause ,Single Center ,Gastroenterology ,Post-transplant lymphoproliferative disorder ,03 medical and health sciences ,0302 clinical medicine ,Immune system ,Adenosine Triphosphate ,hemic and lymphatic diseases ,Internal medicine ,medicine ,Humans ,Child ,Proportional Hazards Models ,Hepatology ,business.industry ,Infant ,Viral Load ,medicine.disease ,Epstein–Barr virus ,Tacrolimus ,Lymphoproliferative Disorders ,Liver Transplantation ,Transplantation ,surgical procedures, operative ,030220 oncology & carcinogenesis ,Child, Preschool ,DNA, Viral ,030211 gastroenterology & hepatology ,Female ,Complication ,business - Abstract
Post-transplant lymphoproliferative disorder (PTLD) is a lethal complication after pediatric liver transplantation, but information regarding risk factors for the development of PTLD remains unclear. This study was to identify characteristics and risk factors of PTLD.A total of 705 pediatric patients who underwent liver transplantation between January 2017 and October 2018 were studied. Impact of clinical characteristics and Epstein-Barr virus (EBV) infection on the development of PTLD was evaluated. In addition, ImmuKnow assay was adopted in partial patients to analyze the immune status.Twenty-five (3.5%) patients suffered from PLTD with a median time of 6 months (3-14 months) after transplantation. Extremely high tacrolimus (TAC) level was found in 2 fatal cases at PTLD onset. EBV infection was found in 468 (66.4%) patients. A higher peak EBV DNA loads (9590 copies/mL) within 3 months was a significant indicator for the onset of PTLD. In addition, the ImmuKnow assay demonstrated that overall immune response was significantly lower in patients with EBV infection and PTLD (P0.0001). The cumulative incidence of PTLD was also higher in patients with lower ATP value (≤187 ng/mL, P0.05).A careful monitoring of EBV DNA loads and tacrolimus concentration might be supportive in prevention of PTLD in pediatric patients after liver transplantation. In addition, application of the ImmuKnow assay may provide guidance in reducing immunosuppressive agents in treatment of PTLD.
- Published
- 2019