Seropositivity for cytomegalovirus and PCR‐EBV monitoring: Protective factors for posttransplant lymphoproliferative disorder in pediatric liver transplant. (17th January 2022)

• Record Type: Journal Article
• Authors: Éboli, Lígia Patrícia de Carvalho Batista; Tannuri, Ana Cristina Aoun; Tannuri, Uenis
• Is Part Of: Pediatric transplantation. Volume 26:Number 4(2022)
• Page Start: n/a
• Page End: n/a
• Publication Date: 2022-01-17
• Subjects: cytomegalovirus -- Epstein‐Barr virus -- immunosuppression -- liver transplantation -- lymphoproliferative disorders -- pediatrics; Transplantation of organs, tissues, etc. in children -- Periodicals; 617.95408305
• DOI: 10.1111/petr.14226
• Languages: English
• ISSNs: 1397-3142

Abstract

Abstract: Background: PTLD is a clinical condition with high mortality. Monitoring EBV replication can be a useful tool to avoid the development of PTLD. Materials and Methods: This was a retrospective analysis of 428 pediatric patients who underwent liver transplantation between 1989 and 2016. The patients were divided into 2 groups (transplanted before 2006, when PCR‐EBV was not monitored, and after 2006, when PCR‐EBV monitoring was started). Patients with continuous PCR measurements for EBV were evaluated for the impact of a reduction in immunosuppression or a change in immunosuppressants on the number of viral copies. A logistic regression model was applied to evaluate factors related to PTLD. Results: The prevalence of PTLD was 4.2%. After monitoring patients with PCR for EBV levels, a predominance of the most severe, monomorphic form of lymphoproliferative disorder was observed ( p = .009). The PTLD mortality was 5%. There was a change in the PCR level after tacrolimus reduction ( p = .002) and after tacrolimus exchange for mTOR ( p = .008). The number of EBV copies was significantly higher ( p = .029) in patients who developed PTLD. In the multiple regression model, seropositivity for CMV was an independent protective factor for lymphoproliferative disorder (OR=0.09; 95% CI 0.02–0.42), reducing the chance of having PTLD adjusted by serology for EBV by 91%. Conclusions: Monitoring the EBV viral load by PCR seems to prevent the emergence of milder forms of lymphoproliferative disorder. Pretransplant seropositivity for CMV is a protective factor for PTLD.