Outcomes of Persistent EBV Viremia Post Transplant in Pediatric Renal Allograft Recipients: Effects of Rituximab Treatment
Pediatric Nephrology and Transplant Immunology Laboratory, Cedars Sinai Medical Center, Los Angeles, CA
Meeting: 2013 American Transplant Congress
Abstract number: 26
Post-Tx lymphoproliferative disorder (PTLD), usually caused by EBV, is a serious complication in renal Tx patients (pts), and a correlation between persistent EBV viremia (PEBV) and late onset PTLD is known. We have shown that Ritux-Rx clears PEBV, but its effect is not sustained. Here we compared the graft and pt outcomes in pts with PEBV who underwent Ritux-Rx to those that did not receive Ritux-Rx.
Methods: 17 primary pediatric tx pts with PEBV were included: Group A: 5 pts with Ritux-Rx (median age: 11y, 3 females, 3 deceased donor (DD) Tx); Group B: 12 pts without Ritux-Rx (median age: 8.5y, 4 females, 8 DDTx). Both groups received Tac/CSA with MMF/Rapa, 5/17 were steroid-free. All pts showed PEBV despite reduction of immunosuppression by 30% and Valganciclovir for 3 months, and 5/17 received Ritux-Rx (375mg/m2/dose, 1-2 doses). EBV serostatus, EBV DNA by PCR, serum creatinine (sCr), development of PTLD and donor specific antibodies(DSA) were monitored. PEBV was defined as EBV viremia >10 copies/PCR for > 3months.
Results:
| Group A (n=5)) | Group B (n=12) | p | |
| Follow up (median days post tx) | 2532 | 1011 | 0.027 |
| EBV sero(-) at Tx | 5(100%) | 8(67%) | NS |
| EBV seroconversion | 5/5(100%) | 8/8(100%) | NS |
| Diagnosis of PEBV (median days post tx) | 73(47-1796) | 186(48-2036) | NS |
| Median EBV DNA (median copies/PCR) | 84 | 38 | NS |
| Peak EBV DNA(median copies/PCR) | 1000 | 131 | 0.002 |
| Resolution of viremia | 2(40%) | 5(41%) | NS |
| Time to resolution(days post diagnosis) | 1647 | 766 | 0.02 |
| PTLD | 0(0%) | 1(8%) | NS |
| sCr at diagnosis (mg/dl) | 1.2±0.4 | 0.8±0.7 | 0.043 |
| sCr at follow up (mg/dl) | 1.3±0.4 | 0.8±0.7 | 0.036 |
| De novo DSA | 0/4(0%) | 5/9(56%) | 0.057 |
| Graft survival(%) | 100 | 100 | NS |
| Patient survival(%) | 100 | 100 | NS |
Conclusions: 1)Post-Tx EBV seroconversion does not guarantee resolution of EBV viremia, 2) Pts with higher peak EBV tended to receive ritux-rx. However, Ritux-Rx in patients with PEBV did not increase chance of resolution or time to resolution 3) There was no difference in graft or pt survival or PTLD in the 2 groups, 4) Pts with higher sCr tended to receive Ritux-rx. However there was no worsening of renal function with follow up in either group. 5)The main difference noted was development of de novo DSA in the group that did not receive Rituximab. Development of DSA may contribute to earlier development of transplant glomerulopathy, therefore close monitoring is necessary.
To cite this abstract in AMA style:
Puliyanda D, Toyoda M, Patel M, Reinsmoen N, Kamil E, Jordan S. Outcomes of Persistent EBV Viremia Post Transplant in Pediatric Renal Allograft Recipients: Effects of Rituximab Treatment [abstract]. Am J Transplant. 2013; 13 (suppl 5). https://atcmeetingabstracts.com/abstract/outcomes-of-persistent-ebv-viremia-post-transplant-in-pediatric-renal-allograft-recipients-effects-of-rituximab-treatment/. Accessed November 23, 2024.« Back to 2013 American Transplant Congress