EBV infection after Renal Transplantation in Children- A report of Iran

سال انتشار: 1397
نوع سند: مقاله کنفرانسی
زبان: فارسی
مشاهده: 357

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شناسه ملی سند علمی:

CNAMED06_097

تاریخ نمایه سازی: 2 تیر 1397

چکیده مقاله:

Definition: Epstein-Barr virus (EBV; now also known as HHV-4) is another DNA herpes virus. The patterns of infection are identical to CMV: primary infection (often from the graft of a seropositive donor), reactivation, or superinfection. Also, as with CMV, the primary infection in an immunosuppressed transplant recipient is more virulent.Epidemiology : The rate of EBV infection in EBV seronegative pediatric transplant recipients (as defined by systemic viremia) ranges from 50% to 80%. The KDIGO guidelines recommend the following post transplant EBV schedule for high-risk D+/R-patient: once in the first week after transplant, at least monthly for the first 3-6 months, then at least every 3 months until the end of the first year with re-initiation of monitoring after treatment for acute rejection.Diagnose: Experience has shown that serology is unreliable as a diagnostic tool for either PTLD or primary EBV infection in immunocompromised patients. These patients show a marked delay in their humoral response to EBV antigens, and many fail to develop immunoglobulin (Ig) M antibodies altogether. Another important drawback is that these patients often receive blood or blood products with the passive transfer of donor antibodies.In the case of EBV, testing can be performed against EB nuclear antigen or viral capsid. The former turns positive early, after recent infection and the latter in more distant infection. More recently, in western countries, PCR amplification of viral DNA is the method most commonly used.Treatment There is no universally accepted treatment for EBV infection post transplant; Reduction in immunosuppression is one modality. The antiviral agents ganciclovir and valganciclovir have activity against EBV. Acyclovir is not effective against EBV. The duration and route of antiviral treatment are not standardized but most centers will treat until the EBV PCR has turned negative. Oral ganciclovir or valganciclovir are also used for prevention of EBV disease. These agents seem to delay the onset of infection rather than reduce the incidence.PTLD: Unlike CMV, EBV infection does not seem to have many indirect effects except for the development of PTLD, which is an uncontrolled proliferation of immune cells (typically B cells) in the setting of posttransplant immunosuppression. In pediatric cases especially, most PTLD is due to Epstein Barr virus. This condition is not a true malignancy since the immune system can regain control of B-cell proliferation if extrinisic immunosuppression is reduced and EBV- directed CD8+ T cells regain function.Posttransplant Lymphoproliferative Disorder (PTLD), 4-5 x more common in children after kidney transplant than adults. Usually caused by proliferation of Epstein Barr virus (EBV) infected B cells Symptoms :Infectious mononucleosis ,Lymphoid hyperplasia,Invasive malignant lymphoma Malignancy associated with polyclonal expansion of B cells associated with rise in EBV titers Incidence of PTLD in pediatric renal transplants is 1.2% overall,Incidence has increased slightly Increased incidence with use of tacrolimus, white race, and cadaver donor. Treatment generally involves reduction in immonosuppression dose and antiviral agents PTLD can present clinically in many ways. Most often, the patient has lymphadenopathy, fever, or symptoms related to pressure on internal organs from an internal lymphoid mass.Diagnosis is made histologically, though imaging can help with appropriate tissue acquisition and staging. Monoclonal or monomorphic PTLD is generally more severe than polyclonal or polymorphic. The most severe forms are indistinguish able from lymphomas. PTLD incidence in pediatric kidney transplantation was previously low at < 1% but then climbed over the last 10 years to more than 4%.Treatment of PTLD usually involves a sequential process. Immunosupperssion reduction is typically the first intervention, followed by the anti- CD20 antibody rituximab or interferon alpha.Chemotherapy is usually reserved for higher – grade cases. Rituximab can be added to either full- dose or attenuated- dose chemotherapy with good results with either type of combination therapy.Method: This is a cross sectional study using descriptive methods. in this research 20 Childs underwent transplantation and were investigated in term of age , gender, the cause of renal failure, EBV serology before and viral load after transplantation ,drug using before and after transplantation Result : In total, out of 20 children 75%were boys and 25% were girls. The average age was 11.26. 70% of patients were D+R+ and 30%were D+R-. Only 2 of them after transplantation had EBV viral load 400, 1300. Renal failures in these individuals were: poly cystic kidney disease, hypo plastic ,PUV ,Neurogenicbladder and FSGS. Most of these children didn t have a history of underlying disease. But among those who had, 1 person had ADHD, 1 had hypothyroidism and 4 of them had hypertension. Donor of renal transplantation had been often unknown, but from 11 persons that it was known 4 of them had cadaver donor. The average time passed from their transplantion wa 34.9 months .Immune suppressive therapy regimen was prednisolon,prograf,cellcept . there was no acceleration between gender and viral load of EBV. And also there was no acceleration between viral load of EBV and cause of renal failure, underlying disease.drug using and cadaver or living donor. Only there was acceleration between viral load of EBV and the duration time of transplantation.

نویسندگان

Amin Sadat Sharif

Fellow of Pediatric Nephrology, Iran University of Medical sciences, Tehran, Iran