Abstract：
The most prevalent malignancy that complicates both adult and pediatric solid organ transplantation is post-transplant lymphoproliferative disorder (PTLD). This study aimed to analyze the clinical and pathological characteristics, treatments, and outcomes of Epstein-Barr virus (EBV) DNAemia and PTLD in pediatric liver transplant recipients. A retrospective chart review was performed on 112 patients less than 18 years of age who underwent isolated orthotopic liver transplantation (OLT) between 2010 and 2022 at Ege University Children\'s Hospital. Data gathered for 1-year post-OLT included age at OLT, EBV, immunoglobulin (Ig)M/IgG status of the donor and recipient, indication for OLT, induction regimen, all immunosuppression levels, date and result of EBV polymerase chain reaction testing, rejection episodes documented by liver biopsy, and the development of PTLD. Forty-nine patients (43.75%) developed EBV DNAemia (median interval from surgery: 2 months, min-max: 2-36), of which 43 (87.8%) grafts came from living donors, and 6 (12.2%) came from deceased donors. Nine (18.4%) patients died during follow-up, and eight (16.3%) developed PTLD. Of these 8 patients; five patients developed EBV-related disease, one child developed hemophagocytic lymphohistiocytosis, one developed aplastic anemia, and one child developed B cell lymphoma. When PTLD patients and without-PTLD patients were compared, pediatric intensive care unit hospitalization, abnormal bone marrow biopsy findings, lymphadenopathy, age at diagnosis of EBV DNAemia, EBV viral load, tacrolimus (FK 506) pre-infection, were higher and tacrolimus 1-month levels were lower in patients with PTLD (p < 0.05). In logistic regression analysis, we showed that the age at diagnosis of EBV DNAemia was significantly higher in children with PTLD (p = 0.045; OR: 1.389; 95% CI: 1.007-1.914). PTLD is a rare but severe complication associated with EBV after OLT. This study demonstrated that PTLD is associated with older age, higher tacrolimus blood levels before EBV DNAemia, and higher peak EBV viral load at 1 month of EBV DNAemia.
摘要：
使成人和小儿实体器官移植复杂化的最普遍的恶性肿瘤是移植后淋巴增生性疾病（PTLD）。本研究旨在分析其临床和病理特征,治疗,小儿肝移植受者的EB病毒（EBV）DNA血症和PTLD的结果。对2010年至2022年在Ege大学儿童医院进行的112例年龄小于18岁的患者进行了回顾性分析。OLT后1年收集的数据包括OLT的年龄，EBV,供体和受体的免疫球蛋白（Ig）M/IgG状态，OLT的指示，诱导方案，所有免疫抑制水平，EBV聚合酶链反应测试的日期和结果，肝活检记录的排斥反应，以及PTLD的发展。49例患者（43.75%）发生EBVDNA血症（手术的中位间隔：2个月，最小-最大：2-36），其中43例（87.8%）移植物来自活体捐赠者，6人(12.2%)来自已故捐献者。9名（18.4%）患者在随访期间死亡，八个（16.3%）发展了PTLD。在这8名患者中，有5名患者发展为EBV相关疾病，一个孩子出现噬血细胞淋巴组织细胞增多症,一个患了再生障碍性贫血,一个孩子患上了B细胞淋巴瘤.当PTLD患者和无PTLD患者进行比较时，儿科重症监护病房住院，异常骨髓活检结果，淋巴结病，诊断为EBVDNA血症的年龄，EBV病毒载量,他克莫司（FK506）感染前，PTLD患者的1个月水平较高，他克莫司较低（p<0.05）。在逻辑回归分析中，我们显示,PTLD患儿诊断EBVDNA血症的年龄显著较高(p=0.045;OR:1.389;95%CI:1.007~1.914).PTLD是OLT后与EBV相关的罕见但严重的并发症。这项研究表明，PTLD与年龄有关，EBVDNA血症前他克莫司血液水平较高，EBVDNA血症1个月时EBV病毒载量峰值较高。
