Clinical Analysis Of Epstein-Barr Virus Infection After Pediatric Liver Transplantation

Objective To study the clinical features and risk factors of Epstein-Barr virus infection in pediatric liver transplantation patients.Methods Data were collected as follows:(1) the donor information :Cytomegalovirus serological status,Epstein-Barr virus serological status,Human leukocyte antigen(HLA) locus.(2) the recipient information:gender,age at the time of transplant,body weight,preoperative diagnosis,preoperative surgery,preoperative blood transfusion,PELD score,total bilirubin,hemoglobin,platelet,prothrombin time(PT),international normalized ratio(INR).(3)the information of operation and graft:the operation time,intraoperative blood loss,intraoperative red blood cell transfusion,plasma transfusion,intraoperative immunity-inducing drugs,intubation time,ICU stay time,postoperative hospital stay. The information of graft includes:the weight of the graft, graft type,cold ischemia time,warm ischemic time,Graft to recipient Ratio.( 4) postoperative information:follow-up time,postoperative complications of arterial, portal vein complications,biliary leakage,acute rejection,repeat surgery,follow-up time,postoperative complications of arterial,portal vein complications,biliary leakage,acute rejection,repeat surgery,supratheraputic tacrolimus level,EBV-DNA load,time of EBV infection,symptoms of EBV infection,efficacy of antiviral treatmen.The pediatric patients treated by the same liver transplant surgical team in Beijing Friendship Hospital of Capital Medical University during April 2014 to July 2015 were included in our study. The real-time PCR technology was used to monitor the EBV-DNA load in the whole blood and plasma specimens for liver transplant recipients.The cases were divided into infection group and non-infection group based on the EBV infection,to analyse the prevalence, clinical features, risk factors, antiviral treatment efficacy and survival rate of EBV infection. Binominal Logistic regression analysis is used to analyse the risk factors of EBV infection. Kaplan-Meier suivival curve is used to draw the survival curve,and Log-rank test to analysis of the survival curves discrepancy. When P <0.05 considered statistically significant.Results 91 patients with end-stage liver disease following liver transplantation wereincluded in this study,of which 40 were males(43.96%),51females(56.04%).The median age at transplant was 12.97 months(3.3-186.4),the median weight of 10Kg(4.3-48),and median postoperative follow-up time was 12.0 months(4.2-20.9). The positive rate of EBV-DNA in whole blood samples was significantly higher than plasma samples(P <0.001) for the recipients. A total of 43 cases(47.25%) of pediatric recipients develop Epstein-Barr infection,including 28 cases(65.12%) occurred 3 months postoperation. In EBV-infected group,there were 19 cases with clinical symptoms.Compared with cases with no clinical symptoms group,the EBV-DNA load was not significant difference(P = 0.287). Regression analysis of risk factors for EBV infection showed that low body weight at the time of transplant, supratheraputic tacrolimus level, the occurance of postoperative acute rejection increase the risk of EBV infection. Further founding showed the supratheraputic tacrolimus level within 1month post-transplantation impacted the development of EBV infection at 3 to 6 months post-transplantation. EBV-DNA load significantly decreased after the treatment in the recipients with EBV infection(P = 0.011),meanwhile EBV-DNA turned negative only in some cases. Survival analysis showed no significantly difference between cases in EBV infection group and non-infection group(Log rank test,P=0.485).Conclusion The whole blood samples is more efficiently than the plasma specimen in monitoring EBV-DNA in pediatric liver transplantation recipients.EBV infection occurred in the early postoperative period in pediatric liver transplantation recipients,and there was no significant correlation between the clinical symptoms with EBV-DNA load. Low body weight at the time of transplant, supratheraputic tacrolimus level, the occurance of postoperative acute rejection are independent risk factors of EBV infection in pediatric liver transplant recipients. The adoption of measures including closely monitoring of EBV-DNA load,immunosuppression level and clinical interventions may improve the prognosis in pediatric liver transplantation recipients with EBV infection.