TY - JOUR
T1 - Viral load of EBV DNAemia is a predictor of EBV-related post-transplant lymphoproliferative disorders in pediatric renal transplant recipients
AU - Colombini, Elisa
AU - Guzzo, Isabella
AU - Morolli, Federica
AU - Longo, Germana
AU - Russo, Cristina
AU - Lombardi, Alessandra
AU - Merli, Pietro
AU - Barzon, Luisa
AU - Murer, Luisa
AU - Piga, Simone
AU - Ciofi Degli Atti, Marta Luisa
AU - Locatelli, Franco
AU - Dello Strologo, Luca
PY - 2017
Y1 - 2017
N2 - Background: Post-transplant lymphoproliferative disorder (PTLD) is a severe complication of solid organ transplantation that can be classified into two major subtypes, namely, early lesions and non-early lesions, based on histopathological findings. In the vast majority of cases, proliferating cells are B lymphocytes and, most frequently, proliferation is induced by Epstein–Barr virus (EBV) infection. Methods: The aim of our study was to evaluate the natural history of EBV infection and its possible evolution toward PTLD in a pediatric cohort of patients who received a renal transplant between January 2000 and December 2013. A total of 304 patients were evaluated for this study, of whom 103 tested seronegative for EBV at transplantation. Results: Following transplantation, 50 of the 103 seronegative patients (48.5%) developed a first EBV infection, based on the results of PCR assays for EBV DNA, with 19 of these patients ultimately reverting to the negative state (<3000 copies/μl). Among the 201 seropositive patients only 40 (19.9%) presented a reactivation of EBV. Non-early lesions PTLD was diagnosed in ten patients, and early lesions PTLD was diagnosed in five patients. In all cases a positive EBV viral load had been detected at some stage of the follow-up. Having a maximum peak of EBV viral load above the median value observed in the whole cohort (59,909.5 copies/μl) was a significant and independent predictor of non-early lesions PTLD and all PTLD onset. Conclusions: A high PCR EBV viral load is correlated with the probability of developing PTLD. The definition of a reliable marker is essential to identify patients more at risk of PTLD and to personalize the clinical approach to the single patient.
AB - Background: Post-transplant lymphoproliferative disorder (PTLD) is a severe complication of solid organ transplantation that can be classified into two major subtypes, namely, early lesions and non-early lesions, based on histopathological findings. In the vast majority of cases, proliferating cells are B lymphocytes and, most frequently, proliferation is induced by Epstein–Barr virus (EBV) infection. Methods: The aim of our study was to evaluate the natural history of EBV infection and its possible evolution toward PTLD in a pediatric cohort of patients who received a renal transplant between January 2000 and December 2013. A total of 304 patients were evaluated for this study, of whom 103 tested seronegative for EBV at transplantation. Results: Following transplantation, 50 of the 103 seronegative patients (48.5%) developed a first EBV infection, based on the results of PCR assays for EBV DNA, with 19 of these patients ultimately reverting to the negative state (<3000 copies/μl). Among the 201 seropositive patients only 40 (19.9%) presented a reactivation of EBV. Non-early lesions PTLD was diagnosed in ten patients, and early lesions PTLD was diagnosed in five patients. In all cases a positive EBV viral load had been detected at some stage of the follow-up. Having a maximum peak of EBV viral load above the median value observed in the whole cohort (59,909.5 copies/μl) was a significant and independent predictor of non-early lesions PTLD and all PTLD onset. Conclusions: A high PCR EBV viral load is correlated with the probability of developing PTLD. The definition of a reliable marker is essential to identify patients more at risk of PTLD and to personalize the clinical approach to the single patient.
KW - Children
KW - Epstein–Barr virus
KW - Viral load
KW - Renal transplant
KW - Post-transplant lymphoproliferative disorder
KW - Children
KW - Epstein–Barr virus
KW - Viral load
KW - Renal transplant
KW - Post-transplant lymphoproliferative disorder
UR - http://hdl.handle.net/10807/228314
U2 - 10.1007/s00467-017-3627-2
DO - 10.1007/s00467-017-3627-2
M3 - Article
SN - 0931-041X
VL - 32
SP - 1433
EP - 1442
JO - Pediatric Nephrology
JF - Pediatric Nephrology
ER -