Chronic renal failure in a 10-year National Cohort of Pediatric Heart Transplant recipients

Abstract

compared to control patients with low/absent viral loads. Results: Data were analyzed on 71 pediatric heart transplant recipients who had serial EBV-PCR studies since 1997; chronic high load (20 pts) low load (39), absent load (12). High load patients included 7 with prior early onset PTLD, 8 with symptomatic EBV infection and 5 with no prior clinical EBV disease. Of these, 8/20 (40%) developed the following B cell lesions at a mean of 6 years (range 2.4 –7.9) after transplant; Burkitt’s lymphoma (4 patients), recurrent or refractory polymorphic PTLD (3, including CNS relapse in one case), and a cutaneous marginal zone B cell lymphoma in 1. Among 51 controls with low or absent viral loads, only 2 (3.9%: P 0.001 control vs. high load) developed late PTLD/ lymphoma (EBV-negative plasma cell PTLD and peripheral T cell lymphoma, 1 case each). Conclusions: Chronic high EBV-load carrier state in the asymptomatic heart transplant recipient is not benign and is a strong predictor of de novo or recurrent PTLD, with the majority being of monomorphic / lymphomatous histology.