Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Hall C & D
*Purpose: EBV infection represents a significant morbidity factor in KTx Pts, especially EBV sero(-) Ped as infections tend to be more severe and recurrent, increasing a risk for post-Tx lymphoproliferative disorder (PTLD). EBV infections are regulated primarily by EBV-Ab & EBV-Tc. Here, we monitored Ped KTx Pts for EBV viremia, EBV-Ab & EBV-Tc post-Tx to establish best management practices in EBV sero(-) Pts.
*Methods: EBV-PCR monitoring was done for median 9 months (M, 1-98M) post-Tx in 18 Pts. EBV-Ab levels in archived plasma were measured by ELISA. EBV-Tc by intracellular IFNγ flow cytometry was tested 1-2 times. EBV-PCR >5 copies/PCR, EBV-Ab >1.0U & EBV-Tc >0.1% were considered positive. All pts received induction therapy and were maintained on tacrolimus & MMF w/ or w/o steroids, and valganciclovir prophylaxis. Treatment for EBV infection consisted of MMF reduction and valganciclovir w/ or w/o rituximab.
*Results: Of 18 Pts, 8 (44%) were sero(-) (all D+) and 10 sero(+) at Tx. Of 10 sero(+) Pts, 8 had no viremia and 2 (20%) had viremia once w/ 8 and 18 copies/PCR; 8 w/o viremia and 1 w/ 8-copy viremia showed both EBV-Ab (2.1±1.1U) and EBV-Tc (0.8±0.7%) consistently (+), and the minimum EBV-Ab levels detected were 1.0U, while the remaining 1 w/ 18-copy viremia showed EBV-Tc(+), but EBV-Ab(-). Of 8 sero(-) Pts, 5 (63%) had viremia, all recurrent viremia. Four of the 5 Pts (80%) showed both EBV-Ab(+) and EBV-Tc(+) at most recent follow up; 1 seroconverted at 1M post-1st viremia, however, 2 other Pts at 2-3M, and the 4th Pt >7M. The peak EBV levels were 179±219 pre- vs. 10±5 copies/PCR post-seroconversion. The remaining 1 sero(-) Pt w/ viremia showed EBV-Tc(+) at 2 weeks post-1st viremia, but EBV-Ab(-) even at 4M, and had recurrent viremia w/ 500 copies/PCR. Other 3 sero(-) Pts w/o viremia were EBV-Ab(-) and EBV-Tc(-). No Pt had PTLD.
*Conclusions: EBV sero(-) Ped KTx Pts are at high risk for severe and recurrence of EBV infection. Seroconversion at several months post-1st viremia is common, and detection of both stable EBV-Ab(+) and EBV-Tc(+) is required for freedom from infection. Thus, monitoring for both EBV-Ab & EBV-Tc levels is important in designing management strategies for EBV infection in sero(-) Pts.
To cite this abstract in AMA style:Shin B, Pizzo H, Puliyanda D, Petrosyan A, Lovato D, Jordan SC, Toyoda M. Anti-ebv Antibody (ebv-ab) And Ebv-specific Cytotoxic T Cell (ebv-tc) Positivity Are Essential To Control Viremia In Seronegative (sero[-]) Pediatric Kidney Transplant Recipients (ped Ktx Pts). [abstract]. Am J Transplant. 2019; 19 (suppl 3). https://atcmeetingabstracts.com/abstract/anti-ebv-antibody-ebv-ab-and-ebv-specific-cytotoxic-t-cell-ebv-tc-positivity-are-essential-to-control-viremia-in-seronegative-sero-pediatric-kidney-transplant-recipients-ped-ktx-pts/. Accessed February 24, 2020.
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