Chronic high Epstein-Barr viral load carriage in pediatric small bowel transplant recipients

• Published in: Pediatric transplantation Vol. 14; no. 4; pp. 549 - 553
• Main Authors: Lau, Audrey H., Soltys, Kyle, Sindhi, Rakesh K., Bond, Geoffrey, Mazariegos, George V., Green, Michael
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.06.2010; Blackwell
• Subjects: Adenitis; Asymptomatic infection; Biological and medical sciences; Carrier State - virology; Child; Children; Chronic Disease; Chronic infection; Complications; Data processing; Enteritis; Epstein-Barr virus; Epstein-Barr Virus Infections - epidemiology; Female; General aspects; Herpesvirus 4, Human - isolation & purification; Humans; Infectious diseases; intestinal transplantation; Intestine; Intestine, Small - transplantation; Liver Transplantation; Male; Medical sciences; Pediatrics; Pennsylvania - epidemiology; Peripheral blood; Population Surveillance; post-transplant lymphoproliferative disorder; posttransplant lymphoproliferative disorders; Prospective Studies; Serology; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Tumors; Viral diseases; Viral Load; Pennsylvania; Pediatrics; Hemopathy; Transplantation; Epstein Barr virus; Homotransplantation; intestinal transplantation; Small intestine; Posttransplant lymphoproliferative disorder; Surgery; Lymphoproliferative syndrome; Healthy carrier; Graft; Epstein-Barr virus; Viral load; Child; Gammaherpesvirinae; Human; High; post-transplant lymphoproliferative disorder; Digestive system; Herpesviridae; Recipient; Infection; Virus; Chronic; Treatment; Viral disease; Colonization
• ISSN: 1397-3142; 1399-3046
• DOI: 10.1111/j.1399-3046.2009.01283.x

Lau AH, Soltys K, Sindhi RK, Bond G, Mazariegos GV, Green M. Chronic high Epstein–Barr viral load carriage in pediatric small bowel transplant recipients.
Pediatr Transplantation 2010: 14:549–553. © 2010 John Wiley & Sons A/S. :  The development of EBV infection and PTLD is normally associated with a high EBV load in peripheral blood. Often, children undergoing primary or reactivation of EBV infection subsequent to ITx will have chronically elevated EBV loads. To better understand this phenomenon and its consequences, we retrospectively reviewed the records of children who underwent ITx (either isolated or part of multivisceral transplantation) at our center from 1992 to 2007, to identify chronic high EBV load carriers in this population. CHL state was defined as the presence of high load for >50% of samples for greater than or equal to six months following either asymptomatic infection or complete clinical resolution of EBV disease/PTLD. Thirty‐five CHL carriers were identified from our patient population. Pretransplant serologies were available on 34 of these patients: 17 were EBV negative and 17 seropositive; one had unknown EBV serostatus prior to transplant. Seven of the 17 seronegative patients developed their CHL carrier state at the time of their primary EBV infection. Thirteen of the 35 (37%) HLC patients developed EBV disease after meeting the definition of high‐load carrier states. EBV‐related diseases developing in CHL carriers included EBV adenitis (n = 1), EBV enteritis (n = 7), PTLD (n = 4), and EBV+ spindle cell tumor (n = 1). Disease was seen in 7/17 of the seronegative (one PTLD) and 6/17 of the seropositive patients (three PTLD). Thirteen of 35 patients (37%) resolved their CHL state without apparent sequelae while nine remain asymptomatic CHL carriers. Three children have had more than one episode of CHL. These data provide important information about the outcome of chronic EBV high‐load carriage in pediatric intestinal transplant recipients.