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Impact of immunosuppression on the development of Epstein-Barr virus (EBV) viremia after pediatric liver transplantation.

Abstract：

OBJECTIVES:Pediatric liver transplant (OLT) patients are at risk of posttransplant lymphoproliferative disease (PTLD) from Epstein-Barr virus (EBV). This study examined the impact of induction and immunosuppression on EBV viremia. METHODS:A retrospective chart review was performed on 197 pediatric patients and induction regimen, immunosuppression levels, and EBV viremia were documented for 1 year post-OLT. Logistic regression models determined associations between induction, immunosuppression, and EBV. RESULTS:Fifty six percent of patients developed EBV viremia. Incidence of EBV viremia was 73% with antithymocyte globulin (ATG), 63% with daclizumab, and 39% for neither, though the trend was not significant [ATG: odds ratio (OR) 0.19; 95% confidence interval (CI) 0.024-1.58; P = .125; daclizumab OR; 1.07; 95% CI 0.270-4.23; P = .925]. Tacrolimus immunosuppression levels were supratherapeutic 28.7% of the time; however, only supratherapeutic tacrolimus levels between 0 and 2 weeks increased EBV viremia at 2 to 4 weeks post-OLT (OR 1.80; 95% CI 1.10-2.94; P = .02). Three patients developed PTLD. CONCLUSIONS:The use of ATG and daclizumab induction likely does not play a role in the development of EBV viremia. Supratherapeutic tacrolimus levels 0 to 2 weeks post-OLT impact the development of EBV viremia at 2 to 4 weeks. The incidence of PTLD was low, suggesting better EBV and immunosuppression monitoring plays an important role in reducing PTLD.

journal_name

Transplant Proc

journal_title

Transplantation proceedings

authors

Lu BR,Park KT,Hurwitz M,Cox KL,Berquist WE

doi

10.1016/j.transproceed.2012.04.035

subject

Has Abstract

pub_date

2013-01-01 00:00:00

pages

301-4

issue

1

eissn

0041-1345

issn

1873-2623

pii

S0041-1345(12)00671-9

journal_volume

45

pub_type

杂志文章

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