Transplantation-related Immunosuppression Responsible for EBV-related Disorders

Abstract

Nephrology| January 01 2000 Transplantation-related Immunosuppression Responsible for EBV-related Disorders AAP Grand Rounds (2000) 3 (1): 9–10. https://doi.org/10.1542/gr.3-1-9 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Twitter LinkedIn Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Transplantation-related Immunosuppression Responsible for EBV-related Disorders. AAP Grand Rounds January 2000; 3 (1): 9–10. https://doi.org/10.1542/gr.3-1-9 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search nav search search input Search input auto suggest search filter All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: herpesvirus 4, human, natural immunosuppression, therapeutic immunosuppression, transplantation Source: Ellis D, Jaffe R, Green M, et al. Epstein-Barr Virus-related disorders in children undergoing renal transplantation with tacrolimus-based immunosuppression. Transplantation. 1999;68;997–1003. This paper presents a retrospective analysis of Ebstein-Barr (EBV) associated complications in renal transplant patients at the Children’s Hospital of Pittsburgh treated with an immunosuppressive regimen consisting of tacrolimus (FK506) and prednisone between 1989–1987. Pre-transplant EBV status was documented for all recipients and for 72% of the donors. By 1995, it was apparent that EBV represented a significant risk for post-transplant complications and so EBV status was prospectively monitored in all patients from then on. The authors divided the patients into 2 groups. Group I consisted of 51 patients who were transplanted from 1989–95 and group II of 30 patients transplanted after 1995 and in whom EBV studies were obtained prospectively. Of the 51 recipients (mean age 11.6 years) in group I, 26 patients (51%) were EBV+. In group II (mean age 9.5 years), 9 patients (30%) were EBV+. There were 6 proven and 1 suspected case of post-transplant lymphoproliferative disease (PTLD) in group I and 2 cases of malignant lymphoma. There were 2 proven and 1 suspected case of PTLD in group II and no cases of malignant lymphoma. All cases of PTLD and malignant lymphoma were in patients who were EBV- and had received a graft from an EBV+ donor. EBV disease did not develop in recipients who were EBV+ prior to transplantation or in any EBV- recipients of an EBV- donor graft. Fifteen of 19 patients in group 2 who received EBV+ grafts seroconverted in a mean of 6.6 months after transplantation despite the fact that only one patient did not receive either prophylactic acyclovir, ganciclovir, CMV hyperimmune globulin or some combination of the three. The incidence of PTLD and malignant lymphoma was 17.6% (9 cases) in group I, and 10% (3 cases) in group II. All children recovered after a reduction in immunosuppression and treatment with antiviral therapy. The authors propose a strategy for the surveillance and treatment of EBV-related disorders in EBV- recipients of EBV+ organ transplants. This paper is important to pediatricians because children are more likely to be EBV- prior to transplantation. Tacrolimus is an attractive agent for post-transplant pediatric patients because it avoids the long-term use of steroids and the attendant, serious side effects that result.1 However, the risk of PTLD or malignant lymphoma is a major drawback. Potent immunosuppression and EBV exposure to an EBV- patient are both necessary for the development of PTLD or malignant lymphoma. The main risk is to patients who are seronegative for EBV at the time of transplantation and who receive an organ from an EBV seropositive donor. Patients who are EBV+ or who receive organs from EBV-donors appear to have little risk of developing PTLD. Furthermore, patients who are treated with tacrolimus for other conditions such as focal segmental glomerulosclerosis do not develop PTLD or malignant lymphoma. It is clear that meticulous attention to EBV status is... You do not currently have access to this content.