The role of quantitative Epstein-Barr virus polymerase chain reaction and preemptive immunosuppression reduction in pediatric liver transplantation: A preliminary experience

Debora Kogan-Liberman, Margaret Burroughs, Sukru Emre, Anne Moscona, Benjamin L. Shneider

Research output: Contribution to journalArticle

43 Citations (Scopus)

Abstract

Background: Risk factors for the development of posttransplant lymphoproliferative disease (PTLD), a major cause of morbidity and mortality after pediatric liver transplantation, are primary Epstein-Barr virus (EBV) infection and intensity of immunosuppression. The authors assessed monitoring of EBV replication and preemptive immunosuppression reduction in pediatric liver transplant recipients. Methods: The authors prospectively followed monthly EBV-quantitative competitive polymerase chain reaction to measure EBV replication in 23 patients who underwent liver transplant between July 1997 and November 1998. Preemptive immunosuppression reduction was instituted for significant EBV replication. Patients were followed up for at least 1 year and divided in two groups for analysis (group 1, pretransplant seronegative for EBV [13 patients]; group 2, seropositive for EBV [10 patients]). Results: In group 1, 9 of 13 patients had positive polymerase chain reaction results at a mean time of 22.4 weeks after transplantation. All but one of these patients were asymptomatic. In seven of nine patients, preemptive immunosuppression reduction was undertaken without development of PTLD or rejection. In two of nine patients, immunosuppression could not be continuously reduced, and both patients experienced low-grade and medically responsive PTLD. In no patient in group 2 did an EBV-positive viral load or PTLD develop. Conclusions: Prospective longitudinal measurement of EBV by quantitative competitive polymerase chain reaction permits early detection of asymptomatic viral replication. Subsequent preemptive reduction of immunosuppression may prevent the progression to PTLD.

Original languageEnglish (US)
Pages (from-to)445-449
Number of pages5
JournalJournal of Pediatric Gastroenterology and Nutrition
Volume33
Issue number4
DOIs
StatePublished - 2001
Externally publishedYes

Fingerprint

liver transplant
Human herpesvirus 4
immunosuppression
Human Herpesvirus 4
Liver Transplantation
Immunosuppression
polymerase chain reaction
Pediatrics
Polymerase Chain Reaction
virus replication
Virus Replication
Epstein-Barr Virus Infections
Liver
viral load
Viral Load
morbidity
risk factors
Transplantation
Morbidity
Transplants

Keywords

  • Epstein-Barr virus
  • Liver transplantation
  • Lymphoproliferative disease
  • Prevention

ASJC Scopus subject areas

  • Gastroenterology
  • Histology
  • Medicine (miscellaneous)
  • Food Science
  • Pediatrics, Perinatology, and Child Health

Cite this

The role of quantitative Epstein-Barr virus polymerase chain reaction and preemptive immunosuppression reduction in pediatric liver transplantation : A preliminary experience. / Kogan-Liberman, Debora; Burroughs, Margaret; Emre, Sukru; Moscona, Anne; Shneider, Benjamin L.

In: Journal of Pediatric Gastroenterology and Nutrition, Vol. 33, No. 4, 2001, p. 445-449.

Research output: Contribution to journalArticle

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