Relationship of viral load EpsteinBarr virus as a marker predictive lymphoproliferative disease after liver transplant
Abstract number: O248
Hernandez J., Nava M., Casasola J., Arellano J., Farfan R.
Background: Lymphoproliferative disease (ELPT) are a heterogeneous group of lymphoid disorders that can develop in patients undergoing solid organ transplantation. The incidence ranges between 2% adults and 10% in children and reach a mortality rate between 40 and 70%. The wide range of clinical presentations ranging from a mononucleosis syndrome and lymphadenopathy, masses to multiple organ dysfunction. The risks identified in pediatric patients post transplant are the early ages, the use of Tacrolimus, a high viral load and a concomitant low cellular immune response.
Objectives: To describe the relationship between EBV viral load as a predictive marker for the presence of ELPT and clinical characteristics of patients after transplantation of liver in the Hospital Infantil de Mexico "Federico Gomez" in the period January 2005 to January 2008.
Methods: A descriptive, retrospective and observational study of a series of cases.
Results: From January 2005 to January 2008, nine liver transplants were performed, three were high risk by serology (EBV D-/ R +), of which one ELPT development at 100 weeks post-transplant viral load of 1450 genomes / mL plasma. The time of reactivation of EBV infection on average for the nine patients was 3.3 weeks after transplantation. Seven patients belonged to age group <5 years (high risk by age). And 4 ELPT developed ELPT viral loads >800 genomes/mL of plasma. Five of nine patients developed ELPT diagnosed by liver biopsy and immunohistochemistry. All patients had elevated liver enzymes more than 4 times its baseline, 2 patients had atypical lymphocytes in the time of diagnosis and 3 ELPT monocytosis. Two patients had clinical mononucleosis-like and 3 were asymptomatic at the time of diagnosis of ELPT with viral loads of >900 genomes/mL. The patient number 9 ELPT present two events with added diagnosis of acute cellular rejection by biopsy in his second event of ELPT and high viral loads.
Conclusions: Viral load >800 genomes/mL accompanied by elevation in liver enzyme values of up to four or more times their normal levels were related to the development of ELPT.
|Session name:||Abstracts 20th European Congress of Clinical Microbiology and Infectious Diseases|
|Location:||Vienna, Austria, 10 - 13 April 2010|
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