*Purpose: Epstein-Barr virus “EBV” infection and post-transplant lymphoproliferative disorders “PTLD” are significant comorbidities in the post-transplant “PT” setting, especially in pediatrics. The synergy among T cell subpopulations (e.g. CD4+ T-helpers, CD8+ T-cytotoxic) modulates immune response. The rationale behind this study was to assess whether peripheral lymphocyte subtype analysis of different subsets was associated with increased risk of EBV infection in children PT.

*Methods: Between Feb 2010 and Jan 2020, 174 patients received a liver transplant “LT”. 39 of these patients (22.4%) had lymphocyte subset profiling at some point. These patients were reviewed 3 months before positive EBV status or 2 months after positive EBV status. EBV positivity was defined as plasma PCR levels >158 copies/mL. EBV PCR was checked monthly in the first year PT, every 3 months in the second year PT, and annually after the third year PT. Reactivation was designated as IgG positive at time of LT, and new viral infection, as IgG negative at time of LT. Statistical significance of values was obtained using the regression analysis tool in Microsoft Excel by comparing the average of peripheral lymphocyte profiles of positive EBV and non EBV patients.

*Results: 8/39 patients who met inclusion were EBV positive (20.5%). 7 (87.5%) had reactivation, and 1 had new viral infection. The average time from LT to positive EBV was 3.9 years. The average age at LT was 1.2 years for positive EBV patients in comparison to 3.4 years for non EBV patients. Indications for LT: 3 had diagnosis of Biliary Atresia, 2 Ornithine Transcarbamylase deficiency, 1 Graft failure, 1 Maple Syrup Urine disease, and 1 Crigler-Najjar syndrome. All EBV positivity led to decreased immunosuppression. There was no PTLD noted. Lymphocyte profiling is shown in Table 1. Overall, EBV positive patients had lower circulating T cells (68.7%), higher B cells (20.9%) and Natural Killer cells (9%). CD4 T Helper lymphocytes were higher in positive EBV patients (31.4%). The CD4/CD8 ratio cells were the highest in positive EBV patients (1.7) and lowest in non EBV patients (1.2). (P<.001 Table 1).

*Conclusions: CD4 T Helper lymphocytes were higher in positive EBV and the CD4/CD8 ratio was significantly higher during active EBV infection and reactivation. Therefore, the risk of concomitant rejection is lower and decreased immunosuppression is well tolerated. Future larger controlled studies are needed to validate these findings and may offer development of non-invasive markers to diagnose EBV infection.

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