Transplantation 1993 Dec;56(6):1394-8

Epstein-Barr virus serology and Epstein-Barr virus-associate lymphoproliferative disorders in pediatric liver transplant recipients

Sokal EM, Caragiozoglou T, Lamy M, Reding R, Otte JB
Department of Pediatrics, Virology, and Pediatric Surgery, Cliniques St. Luc,
Universite Catholique de Louvain, Brussels, Belgium
Abstract
Epstein-Barr virus serology was performed before and after transplantation in
116 patients of a total series of 261 pediatric OLT recipients. Thirty-nine
percent had no immunity before OLT, but this percentage decreased to 11.2% at 6
months and 10.5% at 2 years after transplantation. In this series, 10 children
developed a B cell lymphoproliferative disease. Four had adenotonsillar
involvement, 2 of them with associated digestive tract invasion. Three of these
are alive, 2 after retransplantation for chronic rejection subsequent to arrest
of immunosuppression. The fourth died from bone marrow aplasia. Three patients
with multiorgan involvement died from multisystemic failure. The remaining 3
patients had a pseudotumoral mass. Two of these are alive, 1 after
retransplantation for hepatic localization and secondary vascular and biliary
complication. The last died from cachexia. Four patients developed the syndrome
after viral reactivation, and 6 after primo infection. Four patients were under
FK506 rescue therapy. We conclude that a high rate of EBV primo infection is
observed in the first months after transplantation. A significant percentage
will develop EBV-associated lymphoproliferative disease, which causes death in
half of the patients, including all these with multiorgan involvement. Half of
the patients may survive, but because immunosuppression must be stopped,
retransplantation for chronic rejection is often necessary in survivors