Significance of detecting Epstein-Barr-Specific sequences in the peripheral blood of asymptomatic pediatric liver transplant recipients

Pediatric allograft recipients are at increased risk for Epstein-Barr virus (EBV)-associated illnesses. The early identification and diagnosis of EBV-a ssociated disorders is critical because disease progression can often be cu rtailed by modification of immunosuppression. We have previously shown that detection of EBV-specific sequences in the circulation by polymerase chain reaction (PCR) correlated well with the clinical symptoms of EBV infection . The purpose of the current study is to determine the significance of dete cting EBV-specific sequences by PCR in asymptomatic pediatric liver transpl ant recipients. Peripheral-blood DNA was analyzed for the EBV genes, coding from the nuclear antigen 1 (EBNA-1) and the viral capsid antigen (gp220) b y PCR. Samples from asymptomatic pediatric liver transplant recipients were analyzed from the immediate postoperative period and at 2- to 4-month inte rvals thereafter. We followed up 13 of these asymptomatic recipients who te sted positive for EBV compared with 7 asymptomatic recipients who tested ne gative for EBV during the early posttransplantation period. Follow-up range d from 1.5 to 4 years posttransplantation. Nine patients (69%) initially po sitive for EBV and asymptomatic ultimately developed symptoms of EBV infect ion, including fever, lymphadenopathy, rash, respiratory and gastrointestin al symptoms, and/or hepatitis. Five of these patients (56%) went on to deve lop posttransplant lymphoproliferative disorder based on histological exami nation of biopsied tissue and immunohistochemical identification of the EBV antigen/DNA in tissue. This is the first report suggesting that detection of EBV-specific sequences in the absence of symptoms may herald impending E BV-associated disorders. Thus, routine monitoring for circulating EBV seque nces in asymptomatic recipients may be useful in the early identification o f those at risk for developing EBV-associated disease and its ultimate prev ention. Copyright (C) 2000 by the American Association for the Study of Liv er Diseases.