Significance of Detecting Epstein-Barr-Specific Sequences in the Peripheral Blood of Asymptomatic Pediatric Liver Transplant Recipients

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Vol. 6, Issue 1, pp. 62-66, January 2000

Significance of Detecting Epstein-Barr-Specific Sequences in the Peripheral

Blood of Asymptomatic Pediatric Liver Transplant Recipients

R. Krieger, Olivia M. ez, Sheri M. Krams, ,

So, and O. Esquivel

>From the Stanford University Medical Center, Stanford, CA.

Pediatric allograft recipients are at increased risk for Epstein-Barr virus

(EBV)-associated illnesses. The early identification and diagnosis of

EBV-associated disorders is critical because disease progression can often

be curtailed by modification of immunosuppression. We have previously shown

that detection of EBV-specific sequences in the circulation by polymerase

chain reaction (PCR) correlated well with the clinical symptoms of EBV

infection. The purpose of the current study is to determine the significance

of detecting EBV-specific sequences by PCR in asymptomatic pediatric liver

transplant recipients. Peripheral-blood DNA was analyzed for the EBV genes,

coding from the nuclear antigen 1 (EBNA-1) and the viral capsid antigen

(gp220) by PCR. Samples from asymptomatic pediatric liver transplant

recipients were analyzed from the immediate postoperative period and at 2-

to 4-month intervals thereafter. We followed up 13 of these asymptomatic

recipients who tested positive for EBV compared with 7 asymptomatic

recipients who tested negative for EBV during the early posttransplantation

period. Follow-up ranged from 1.5 to 4 years posttransplantation. Nine

patients (69%) initially positive for EBV and asymptomatic ultimately

developed symptoms of EBV infection, including fever, lymphadenopathy, rash,

respiratory and gastrointestinal symptoms, and/or hepatitis. Five of these

patients (56%) went on to develop posttransplant lymphoproliferative

disorder based on histological examination of biopsied tissue and

immunohistochemical identification of the EBV antigen/DNA in tissue. This is

the first report suggesting that detection of EBV-specific sequences in the

absence of symptoms may herald impending EBV-associated disorders. Thus,

routine monitoring for circulating EBV sequences in asymptomatic recipients

may be useful in the early identification of those at risk for developing

EBV-associated disease and its ultimate prevention.

Liver Transplantation, Vol 6, No 1 (January), 2000: pp 62-66

1527-6465/00/0601-0002$3.00/0

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