Timing of Epstein-Barr virus acquisition and the course of posttransplantation lymphoproliferative disorder in children.

BACKGROUND: To investigate the clinical course and risk factors of Epstein-Barr virus (EBV)-associated posttransplantation lymphoproliferative disorder (PTLD) after liver transplantation (LT) among children in Taiwan where children acquired EBV infection in early childhood.

METHODS: In the retrospective study, 67 children underwent LT in our hospital and survived for more than 3 months were recruited. Various predisposing risk factors, including viral status, nutritional status, age at transplantation, and medications, were assessed. The diagnosis of EBV-associated PTLD in these liver transplanted patients was confirmed by histologic examination.

RESULTS: Eight children developed EBV-associated PTLD after LT, and all (100%) had gastrointestinal tract mucosa-associated lymphoid tissue involvement with the initial presentation as bloody stool. The incidence of PTLD is 11.9% (8/67) in the liver transplanted children in our hospital. Children who received LT before 1 year of age had a higher risk of EBV-associated PTLD than others (relative risk [RR]=10.37, P=0.006). The absence of EBV nuclear antigen antibody in recipients before LT also increased the risk (RR=8.63, P=0.018). The RR of EBV-associated PTLD increased to 13.3 (P=0.002) in EBV naïve children who received LT before 1 year of age.

CONCLUSIONS: Additional risk of EBV naivity and transplantation age below 1 year was evident in our series to the development of EBV-associated PTLD. Acquired EBV infection in early infancy after the LT may increase the risk of gastrointestinal tract involvement of EBV-associated PTLD in Taiwan.