Epstein-Barr virus in pediatric patients after renal transplantation

Background: Pediatric allograft recipients are at an increased risk for lymphotropic virus-associated disorders, particularly in association with primary EBV infection. Patients and methods: Twenty-nine children, adolescents and young adults after renal transplantation were studied in comparison with a healthy young adult control group for evidence of primary, reactivated or chronic active EBV infection at two different time points. Results: Prevalence of antibodies against viral capsid antigen (VCA) was greater than or equal to 90% in both groups, whereas anti-Epstein-Barr nuclear antigen (EBNA) was detected only in 19 of 26 seropositive patients compared with seropositive controls (p = 0.01). Persistence of EBV DNA in leukocytes for greater than or equal to 6 months was observed in 11 seropositive patients (38%) and one control patient (p < 0.007) using nested polymerase chain reaction. In the transplant recipients, 3 cases of primary EBV infection and 3 cases of chronic active EBV infection were identified. One of these cases developed a non-Hodgkin lymphoma one year later. Conclusion: The results suggest that determination of pretransplant antibody status in recipients, rapid detection of EBV infection in seronegative symptomatic recipients, and regular screening for persistent EBV DNA in patients at risk to develop post-transplantation lymphoproliferative disease should be performed.