Morbidity and Mortality Rate of Post-transplantation Lymphoproliferative Disorders after Epstein-Barr Virus Infection in Liver Transplant Recipients in Shiraz, Iran

Abstract

Background:

Epstein-Barr virus (EBV) primary infection and/or reactivation are suggested to play a significant role in the incidence of post-transplantation lymphoproliferative disorders (PTLD) and some other complications in immunocompromised patients, especially organ recipients. We assessed EBV viral load in EBV/PTLD suspected liver transplant recipients at specified times after transplantation and evaluated the respective clinical findings and post-transplant complications.

Materials and Methods:

Of 696 patients who underwent liver transplantation, the EBV viral load of 127 patients suspected of EBV infection/disease was examined intermittently in this retrospective study. Sampling was performed over a 4-year period from July 2013 to May 2017 using Taq-Man Real-Time Polymerase chain reaction (PCR) assay. Clinical and pathological data were gathered through the review of medical records.

Results:

The most common and leading cause of liver transplantation was HBV end-stage with 12% frequency; however, in 39% of patients, the underlying disease was unknown.

In total, 78 out of 127 (61%) suspected patients exhibited EBV-DNemia, and 19 of them were associated with PTLD. The median viral load in patients with PTLD was significantly higher than in non-affected patients (4035 copy/mL vs.  500 copy/mL, P<0.05). Among the PTLD cases, 13 were living, and six expired. Of the non-PTLD cases, 57 were living, and two expired.

Totally, PTLD was diagnosed clinically in 34 subjects (4.9%). The estimated mortality rate in patients with PTLD was 35% during 1.5 years post-transplantation follow-up.

Conclusion:

We concluded that monitoring of EBV load might detect EBV infection/disease in liver transplant suspected recipients even several weeks before the onset of any manifestation, especially in pediatric cases in whom PTLD incidence and its mortality are high.