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Epidemiology and morbidity of Epstein-Barr virus infection in pediatric renal transplant recipients: a multicenter, prospective study.

AbstractBACKGROUND:
The epidemiology and morbidity of Epstein-Barr virus (EBV) infection in pediatric renal transplant recipients have been characterized insufficiently.
METHODS:
In a prospective, multicenter study among 106 pediatric kidney allograft recipients aged 11.4 ± 5.9 years, we investigated the epidemiology of EBV infection and the relationship between EBV load, EBV serology, and EBV-related morbidity (posttransplant lymphoproliferative disease [PTLD] or symptomatic EBV infection, defined as flu-like symptoms or infectious mononucleosis).
RESULTS:
EBV primary infection occurred in 27 of 43 (63%) seronegative patients and reactivation/reinfection in 28 of 63 (44%) seropositive patients. There was no association between the degree or duration of EBV load and EBV-related morbidity: The vast majority (17 of 18 [94%]) of patients with a high, persistent EBV load remained PTLD-free throughout a follow-up of 5.0 ± 1.3 years, while 2 of 3 (66%) patients with EBV-related PTLD exhibited only a low EBV load beforehand. Eight of 18 (44%) patients with a high, persistent EBV load remained asymptomatic during a follow-up of 5.3 ± 2.9 years. Multivariate analysis identified the EBV high-risk (D(+)/R(-)) serostatus (odds ratio [OR], 7.07; P < .05), the presence of human leukocyte antigen (HLA)-DR7 (OR, 5.65; P < .05), and the intensity of the immunosuppressive therapy (OR, 1.53; P < .01) as independent risk factors for the development of a symptomatic EBV infection.
CONCLUSIONS:
Presence of EBV high-risk seroconstellation, HLA-DR7, and intensity of immunosuppressive therapy are significant risk factors for a symptomatic EBV infection, whereas there is no close association between the degree or duration of EBV load and EBV-related morbidity. Clinical Trials Registration. NCT00963248.
AuthorsBritta Höcker, Helmut Fickenscher, Henri-Jacques Delecluse, Stephan Böhm, Uta Küsters, Paul Schnitzler, Martin Pohl, Ulrike John, Markus J Kemper, Henry Fehrenbach, Marianne Wigger, Martin Holder, Monika Schröder, Heiko Billing, Alexander Fichtner, Reinhard Feneberg, Anja Sander, Sabine Köpf-Shakib, Caner Süsal, Burkhard Tönshoff
JournalClinical infectious diseases : an official publication of the Infectious Diseases Society of America (Clin Infect Dis) Vol. 56 Issue 1 Pg. 84-92 (Jan 2013) ISSN: 1537-6591 [Electronic] United States
PMID23042966 (Publication Type: Clinical Trial, Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't)
Chemical References
  • Antiviral Agents
  • Immunosuppressive Agents
Topics
  • Adolescent
  • Analysis of Variance
  • Antiviral Agents (therapeutic use)
  • Child
  • Epstein-Barr Virus Infections (epidemiology, immunology, therapy, virology)
  • Female
  • Graft Rejection (drug therapy, prevention & control)
  • Herpesvirus 4, Human (immunology, isolation & purification)
  • Humans
  • Immunosuppressive Agents (therapeutic use)
  • Kidney Transplantation (statistics & numerical data)
  • Lymphoproliferative Disorders (epidemiology, etiology, virology)
  • Male
  • Morbidity
  • Prospective Studies
  • Statistics, Nonparametric
  • Transplants (statistics & numerical data)
  • Viral Load

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