Abstract
<h3>Purpose</h3> EBV viremia can progress to a potentially fatal PTLD. Data on the use of IVIg and antiviral agents such as ganciclovir or valganciclovir for the treatment (Rx) of this condition are limited. This study retrospectively evaluated the efficacy of IVIg with the combination of antiviral therapy in reducing EBV viral load and preventing PTLD in pediatric heart transplant patients (pts). <h3>Methods</h3> All pts transplanted since December 2007 were included. IVIg plus antiviral was implemented as empiric Rx in clinically significant EBV viremia polymerase chain reaction (PCR) > 100,000 copies/mL). Pts who were refractory to this tx and had EBV PCR > 250,000 copies/mL received rituximab. The pts were divided into two groups, those that received empiric Rx and those that did not. Pts who did not receive empiric Rx never had EBV viremia or only had EBV viremia at the time of PTLD diagnosis. The change from baseline EBV PCR values over time was evaluated, and the actuarial freedom from PTLD was compared between the two groups. <h3>Results</h3> There were 88 pts in the non-Rx group and 18 pts in the empiric Rx group. In the empiric Rx group, 9 pts received rituximab. The median time of initial EBV viremia incident was 27.7 months after transplantation. Pts on empiric Rx experienced an initial decrease in EBV viral load (p = 0.009) and maintain an acceptable EBV PCR level compared to baseline. None of the treated pts, including those who were refractory, developed PTLD. In the non-Rx group, 5 pts developed PTLD (p = 0.272). <h3>Conclusion</h3> A clinically important finding was observed when EBV viremia was identified with steps implemented to minimize viral load by utilizing IVIg, antivirals, and rituximab. It appeared that PTLD may be avoided though our data did not yet reach statistical significance. A large prospective clinical trial is indicated to support the use of this empiric Rx for the prevention of PTLD.
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