EBV loads and abnormalities of humoral responses were monitored in 51 pediatric
liver transplant recipients as a proposed non-invasive laboratory tool for early detection of changes preceding severe clinical complications. EBV
DNA load, concentrations of
IgM,
IgG,
IgA, and monoclonal
proteins were determined in each blood sample. EBV
DNA was detected in 70.6% of the children,
dysgammaglobulinemia of one or more
Ig isotype was present in 41.2% of them. MG detected in 43.1% of patients correlated with the presence of EBV
DNA (p = 0.003) and was usually preceded by
hypergammaglobulinemia. The median maximum EBV load was significantly higher in EBV
DNA+/MG+ patients than in EBV
DNA+/MG- patients (p = 0.04), although there was no correlation between current viral load and appearance of MG. Four of 15 EBV
DNA-negative patients developed MG, preceded by
hypergammaglobulinemia in two. Minimization or cessation of immunosuppression in 42 patients, in whom abnormal
biomarkers and/or clinical symptoms raised suspicion of
disease progression, permitted complete resolution of abnormalities in all but one patient who developed B-NHL and died. Simultaneous monitoring of
protein profiles and EBV
DNA load together with thorough physical evaluation of children after LTx is important for early implementation of suitable preemptive
therapy.