Backgrounds:

Epstein-Barr virus (EBV) infections cause significant morbidity and mortality in pediatric SOTR. Post-transplant lymphoproliferative disorder is a devastating complication of EBV infection in SOTR. Contemporary data on rates of EBV DNAemia and subsequent PTLD in pediatric SOTR are limited.

Methods

A retrospective cohort study of patients ≤ 21 years of age who received lung, heart, liver, kidney, or multi-organ transplants at TCH between 2010-2018 was completed. Primary outcome was quantifiable EBV DNAemia. Associations with EBV DNAemia were measured using Fisher exact test and multivariate logistic regression. Survival analysis and time to EBV DNAemia were assessed using Kaplan-Meier method.

Results:

Among 687 SOTR, 43% (295) had quantifiable EBV DNAemia; this included 45% (39/87) lung, 62% (161/259) liver, 39% (59/152) heart, 64% (9/14) multi-organ, and 15% (27/175) kidney recipients. Median time to quantifiable DNAemia for patients that developed EBV was 573 (0 – 3237) days (Figure 1). High-risk EBV status (D+/R-) [OR 2.76, 95% CI (1.6 – 4.7), and having a liver transplant [10.84 (6.4 – 18.4)] were associated with the development of EBV DNAemia.

DNAemia was not associated with sex, ethnicity, or era of transplantation. Induction therapy was collinear with organ transplanted and could not be assessed. There was no difference in survival during the study follow-up period (1–9 years) for SOTR with vs. without DNAemia (p=0.08). Overall PTLD occurred in 4% (26/687) of SOTR; this included 6% (5/87) lung, 2% (6/259) liver, 8% (12/152) heart, 0% (0/14) multiorgan, and 2% (3/175) kidney recipients.

Conclusions/Learning Points:

This large contemporary cohort of pediatric SOTR demonstrates high overall rates of EBV DNAemia and relatively low rates of PTLD. Heart SOTR had the highest rate of PTLD, suggesting that further interventions targeting this group may be warranted.

Backgrounds:

Epstein-Barr virus (EBV) infections cause significant morbidity and mortality in pediatric SOTR. Post-transplant lymphoproliferative disorder is a devastating complication of EBV infection in SOTR. Contemporary data on rates of EBV DNAemia and subsequent PTLD in pediatric SOTR are limited.

Methods

A retrospective cohort study of patients ≤ 21 years of age who received lung, heart, liver, kidney, or multi-organ transplants at TCH between 2010-2018 was completed. Primary outcome was quantifiable EBV DNAemia. Associations with EBV DNAemia were measured using Fisher exact test and multivariate logistic regression. Survival analysis and time to EBV DNAemia were assessed using Kaplan-Meier method.

Results:

Among 687 SOTR, 43% (295) had quantifiable EBV DNAemia; this included 45% (39/87) lung, 62% (161/259) liver, 39% (59/152) heart, 64% (9/14) multi-organ, and 15% (27/175) kidney recipients. Median time to quantifiable DNAemia for patients that developed EBV was 573 (0 – 3237) days (Figure 1). High-risk EBV status (D+/R-) [OR 2.76, 95% CI (1.6 – 4.7), and having a liver transplant [10.84 (6.4 – 18.4)] were associated with the development of EBV DNAemia.

DNAemia was not associated with sex, ethnicity, or era of transplantation. Induction therapy was collinear with organ transplanted and could not be assessed. There was no difference in survival during the study follow-up period (1–9 years) for SOTR with vs. without DNAemia (p=0.08). Overall PTLD occurred in 4% (26/687) of SOTR; this included 6% (5/87) lung, 2% (6/259) liver, 8% (12/152) heart, 0% (0/14) multiorgan, and 2% (3/175) kidney recipients.

Conclusions/Learning Points:

This large contemporary cohort of pediatric SOTR demonstrates high overall rates of EBV DNAemia and relatively low rates of PTLD. Heart SOTR had the highest rate of PTLD, suggesting that further interventions targeting this group may be warranted.