Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Hall C & D
*Purpose: Epstein Barr virus (EBV) belongs to the family of herpesvirus and is associated with a wide range of malignancies, including post-transplant lymphoproliferative disorder (PTLD). The early identification of EBV infection and the monitorization of post-transplant viral load through PCR allows therapeutic interventions, such as the immunosuppression (IS) reduction, which may prevent disease progression.
*Methods: Retrospective analysis of clinical, epidemiological and polymerase chain reaction (PCR) assays for EBV DNA in whole blood samples from 45 pediatric kidney- allograft recipients transplanted in our institution between April 2014 and April 2018. EBV PCR was performed monthly for the first 6 months after transplantation, every 3 months until the end of the first post-transplant year, every 6 months after the first year or monthly, if PCR > 0. IS reduction occurred if PCR rising for 3 consecutive months and/or concomitance with another viral infection.
*Results: 45 patients were evaluated during a median follow-up of 26 months (range 3-49 m).The main disease diagnoses were CAKUT 42% (19/45) and glomerulopathy in 24% (11/45), median age at transplantation 10.8 years (range 2.5 – 17.7 years). Thrity five patients (78%) received a deceased kidney transplant and the induction immunossuppression was basiliximab in 64% (29/45) and thymoglobulin in 36% (16/45) patients. The pre transplant recipients EBV sorologic status was negative in 22% (10/45) of children. EBV PCR positivation (any value > zero) occurred in 48% (17/35) of pre transplant EBV soropositive and 50% (5/10) of soronegative patients in a median time of 6.8 months after transplantation (range 0.6 – 36.9 m). Fourthy percent (9/22) of those patients with positive PCR had other concomitant viral infections (cytomegalovirus, parvovirus and polyomavirus). The IS reduction ocurred in 10/22 (45%) and half of them progressed with acute rejection with a higher incidence compared to the group without medication changes (50% x 28%), no graft loss. Three patients evolved with PTLD in the period (incidence 6.6%) after 2, 3 and 10 months of transplantation with 100% graft and pacient survival. The EBV PCR at diagnosis was negative in one patient and 543 and 6.214 copies/mL in the other 2 children.
*Conclusions: EBV PCR positivation occurred in a high percentage of pre transplant soropositive EBV pacientes (48%). The PTLD diagnosis was early after transplantation and negative or low PCR count either before or at the diagnosis did not allow prior reduction of IS in those patients. The EBV PCR monitoring and the manangement of IS probably contributed to the non occurrence of late PTLD cases. The incidence of rejection was higher when IS was reduced and the association with others viral infections (40%) to positive EBV PCR was relevant in our patients.
To cite this abstract in AMA style:Metran C, Araujo ME, Cardoso R, Araujo G, Paula TDe, Cristofani L, Penteado F, Pereira MF, Watanabe A. Quantitative Epstein-Barr Virus Viral Load Monitoring in Pediatric Kidney Transplantation [abstract]. Am J Transplant. 2019; 19 (suppl 3). https://atcmeetingabstracts.com/abstract/quantitative-epstein-barr-virus-viral-load-monitoring-in-pediatric-kidney-transplantation/. Accessed October 31, 2020.
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