The value of prospective monitoring of Epstein–Barr virus DNA in blood samples of pediatric liver transplant recipients

Scheenstra, René; Verschuuren, Erik; Haan, Aalzen de; Mj, Slooff; The, T. H.; Bijleveld, Cma; Verkade, Henkjan J.

doi:10.1111/j.1399-3062.2004.00044.x

Cited by 37 publications

(27 citation statements)

References 24 publications

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“…Monitoring of the EBV DNA level in blood has been used for early identification of lymphoproliferations in transplant patients [Spada et al, 2001;Lee et al, 2005;Kullberg-Lindh et al, 2006;Jang et al, 2008]. However, the EBV load alone has low positive and negative predictive values for post-transplant lymphoproliferative disorder development [Scheenstra et al, 2004]. Therefore, other early markers of EBV-related posttransplant complications have been extensively searched for.…”

Section: Epstein-barr Virus (Ebv) Is a Ubiquitous Humanmentioning

confidence: 99%

Epstein–Barr virus gene expression and latent membrane protein 1 gene polymorphism in pediatric liver transplant recipients

Kasztelewicz

Jankowska

Pawłowska

et al. 2011

Journal of Medical Virology

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Immunosuppressed pediatric transplant recipients are at risk of developing Epstein-Barr virus (EBV)-associated complications (such as post-transplant lymphoproliferative disorders). Monitoring of the EBV DNA level in blood alone has a low predictive value for the post-transplant course of EBV infection and its complications. Therefore, additional prognostic markers are widely sought. The study aim was to analyze EBV gene expression patterns and LMP1 polymorphism in relation to EBV DNA levels in pediatric liver transplant recipients. EBV load measurement, LMP1 variant, and gene expression analysis were performed in collected prospectively multiple blood samples from 30 patients. Several distinct patterns of EBV gene expression were identified: latency 2 (71%), latency 3 (13%), latency 0 (11%), and lytic infection (5%). In most children's multiple blood samples, both EBV gene expression patterns and expression levels of individual EBV genes varied significantly over time. EBV gene expression patterns were not associated with the EBV load. However, the viral load correlated with the LMP1 and LMP2 expression (r = 0.34; P = 0.006, and r = 0.45; P = 0.001, respectively). Two variants of the LMP1 gene were detected, and they were consistent over time in individual patients. A wild type of LMP1 was associated with higher EBV-DNA loads (P = 0.03). This indicates that EBV infection in immunosuppressed patients is a very dynamic process, but changes in the state of EBV infection do not influence significantly the viral load. The latter, however, can be associated with the activity of LMP1 and LMP2 genes, as well as polymorphism of LMP1.

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Section: Epstein-barr Virus (Ebv) Is a Ubiquitous Humanmentioning

confidence: 99%

Epstein–Barr virus gene expression and latent membrane protein 1 gene polymorphism in pediatric liver transplant recipients

Kasztelewicz

Jankowska

Pawłowska

et al. 2011

Journal of Medical Virology

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“…Studies have used varying cut points of EBV load, and a value truly predictive of PTLD development has yet to be determined. Importantly, all patients who have elevated viral loads do not go on to develop PTLD [27,48]. Antiviral therapies may be helpful in preventing PTLD.…”

Section: Preventionmentioning

confidence: 99%

Malignancy After Solid Organ Transplantation: An Overview

2008

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Disclosure:This article discusses the use of acitretin (manufactured by Connetics) for prophylaxis of non-melanoma skin cancers; cyclophosphamide * (Bristol-Myers Squibb), adriamycin * (Pharmacia), prednisone * (Pfizer), vindesine (Lilly/EG Labo; not available in the U.S.), rituximab * (Genentech), and monoclonal anti-IL-6-antibody (multiple manufacturers) for post-transplant lymphoproliferative disorder (PTLD) (clinical trial); vincristine * (Lilly/Gensia Sicor) and bleomycin * (Bristol-Myers Squibb) for PTLD and Kaposi's sarcoma (KS); liposomal daunorubicin (Gilead) for KS (indicated for HIV-associated KS); paclitaxel (BristolMyers Squibb) for KS (indicated for AIDS-associated KS); imatinib (Novartis) and bevacizumab (Genentech) for KS; and matrix metalloproteinase inhibitor COL-3 (CollaGenex) for KS (clinical trial). ( * Drugs marked with asterisks are indicated for use in malignant lymphomas generally, but no specific mention is made of PTLD.)The content of this article has been reviewed by independent peer reviewers to ensure that it is balanced, objective, and free from commercial bias. No financial relationships relevant to the content of this article have been disclosed by the authors, planners, independent peer reviewers, or staff managers. LEARNING OBJECTIVESAfter completing this course, the reader should be able to:1. Describe the most common malignancies encountered after solid organ transplantation.2. Discuss the pathogenesis of malignancy after solid organ transplantation. Administer standard treatment for common post-solid organ transplantation malignancies.This article is available for continuing medical education credit at CME.TheOncologist.com. CME CME ABSTRACT CASE PRESENTATIONA 49-year-old man with no prior medical history initially presented with severe dyspnea progressive over 6 months.The patient underwent an open-lung biopsy that confirmed the diagnosis of idiopathic pulmonary fibrosis. He was assessed for lung transplantation. An extensive pretransplant

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“…Por esto la disponibilidad de los métodos moleculares para seguimiento de estos pacientes es ideal para poder hacer modificaciones en la inmunosupresión y justificar el uso de medicamentos antivirales que deberían disminuir, en teoría, la aparición de estas complicaciones 13 . La medición de la carga viral es cada vez más usada como método de seguimiento en los pacientes con infección por EBV, pues permite hacer modificaciones en el tratamiento inmunosupresor y evalúa los cambios vistos con dicha intervención 14 .…”

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“…El protocolo usado en el hospital de niños de Pittsburgh sugiere seguimiento de la carga viral en intervalos definidos y se presenta en la Tabla 5. El nivel de carga viral para EBV y el tiempo que esta última permanece alto también han sido materia de debate de diferentes estudios; algunos autores sugieren que las cargas virales altas y sostenidas, definida como niveles superiores a 16 000 copias/ mL, por lo menos en el 50% de las ocasiones en que fuera medida, dentro de un periodo de seis meses se asocian con la aparición de complicaciones linfoproliferativas del EBV 13,21 . Otros han reportado que ser receptor seronegativo para EBV y donante seropositivo, tener el alelo HLA-DR7 y el uso de terapia inmunosupresora intensa son los factores más frecuentemente asociados a enfermedad por EBV en trasplantados Scheenstra y colaboradores, reportan que los pacientes seronegativos para EBV previos al trasplante suelen tener cargas virales más altas al infectarse.…”

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Seguimiento con carga viral para virus Epstein- Barr en pacientes pediátricos con trasplante hepático

Mesa

Aristizábal

2015

Rev. Medicas UIS

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RESUMENIntroducción: Los pacientes trasplantados son un reto desde todo punto de vista. La infección por el virus de Epstein-Barr es frecuente y su manejo suele ser difícil por la falta de medicamentos efectivos. Los pacientes con trasplante hepático tienen una alta incidencia de infección/reactivación por virus Epstein-Barr por el riesgo de primoinfección durante este periodo o la reactivación por inmunosupresión. Objetivos: Describir los hallazgos obtenidos con el uso de la carga viral para el virus de Epstein-Barr en el seguimiento de los pacientes pediátricos sometidos a trasplante hepático en una institución de cuarto nivel en Medellín, Colombia. Selección de pacientes: Se revisaron siete historias clínicas de pacientes con trasplante hepáticos escogidos al azar, obteniendo de ellas los datos demográficos, motivo de trasplante, momento de la aparición de la de la carga viral positiva por el virus de Epstein-Barr, evolución de la carga viral, efectos de los medicamentos inmunosupresores y antivirales, y el desenlace de los pacientes. Descripción de casos: La edad promedio de los pacientes al momento del trasplante fue de 28,4 meses, el efecto de los medicamentos antivirales como gangiclovir, valganciclovir, inmunoglobulina contra citomegalovirus, no parece ejercer una disminución adecuada y sostenida de la carga viral. Conclusiones: A pesar de las opciones terapéuticas disponibles para el herpes virus, según lo encontrado en la literatura actual y lo visto los pacientes evaluados, el grado de inmunosupresión parece ser el principal factor para el control de la replicación del virus de Epstein-Barr. Follow up with viral load monitoring for Epstein-Barr virus in pediatric pacients with hepatic transplantABSTRACT Introduction: Transplant patients are a challenge from every point of view. Infection with Epstein-Barr virus is common and management is often hampered by the lack of effective medicaments available. Liver transplant patients have a high incidence of Epstein-Barr virus infection / reactivation because of the the risk of primary infection during this period or immunosuppression associated reactivation. Objectives: Describe the findings when using EBV viral load monitoring in liver transplant patients in an institution of the fourth level in Medellin, Colombia. Selection of patients: Seven medical records from liver transplant patients were randomly chosen obtaining from them demographic data, cause of transplantation, time of the Epstein-Barr virus detection, viral load evolution, effects of immunosuppressive medications over them and the patient´s outcome. Description of patients: Average patient age at transplant was 28,4 months, the effect of antiviral drugs (gangiclovir, valganciclovir, cytomegalovirus immunoglobulin) seems not to be adequate and sustained in decreasing viral load. Conclusions: Although the therapeutic options available for Herpes virus , as found in current literature and seen in our patients, immunosupression degree seems to be the main factor for controlling EBV replication. MÉ...

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The value of prospective monitoring of Epstein–Barr virus DNA in blood samples of pediatric liver transplant recipients

Cited by 37 publications

References 24 publications

Epstein–Barr virus gene expression and latent membrane protein 1 gene polymorphism in pediatric liver transplant recipients

Epstein–Barr virus gene expression and latent membrane protein 1 gene polymorphism in pediatric liver transplant recipients

Malignancy After Solid Organ Transplantation: An Overview

Seguimiento con carga viral para virus Epstein- Barr en pacientes pediátricos con trasplante hepático

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