Pediatric renal transplantation: A retrospective single-center study on epidemiology and morbidity due to EBV

A. Laurent (1) , A. Klich (2) , Pascal Roy (3, 4, 5) , Bruno Lina (6, 7) , B. Kassai (8) , J. Bacchetta (1, 3) , P. Cochat (1)

1 Service de néphrologie, rhumatologie et dermatologie pédiatriques [Hôpital Femme Mère Enfant, HCL]
2 Service de Biostatistique des Hospices Civils de Lyon
3 LBBE - Laboratoire de Biométrie et Biologie Evolutive - UMR 5558
4 Service de Biostatistiques [Lyon]
5 HCL - Hospices Civils de Lyon
6 Virpath - Virpath-Grippe, de l'émergence au contrôle -- Virpath-Influenza, from emergence to control
7 IAI - Institut des Agents Infectieux [Lyon]
8 EPICIME-CIC 1407 de Lyon

Pediatric R-Tx patients are at high risk of developing EBV primary infection. Although high DNA replication is a risk factor for PTLD, some patients develop PTLD with low viral load. In this retrospective single-center study including all pediatric patients having received R-Tx (2003-2012 period), we aimed to identify risk factors for uncontrolled reactions to EBV (defined as the presence of a viral load \textgreater10~000~copies/mL or PTLD). A Cox proportional hazard model was performed. A total of 117 patients underwent R-Tx at a mean age of 9.7~\textpm~5.3~years, 46 of them being seronegative for EBV at the time of R-Tx. During follow-up, 54 patients displayed positive EBV viral load, 22 of whom presenting with primary infection. An uncontrolled reaction to EBV was observed in 24 patients, whilst 4 patients developed PTLD. Univariate and multivariate analyses suggested the following risk factors for an uncontrolled reaction: age below 5~years, graft from a deceased donor, >=5 HLA mismatches, EBV-seronegative status at the time of R-Tx, and a secondary post-Tx loss of anti-EBNA. Monitoring anti-EBNA after R-Tx may contribute to the early identification of patients at risk for uncontrolled reaction.

Mots clés: Adolescent; Child; Preschool; EBV; EBV nuclear antigen; Epstein-Barr Virus Infections; Female; Follow-Up Studies; Humans; Infant; Newborn; Kaplan-Meier Estimate; Kidney Transplantation; Male; Outcome Assessment (Health Care); pediatric renal transplantation; PLTD; Postoperative Complications; Proportional Hazards Models; Retrospective Studies; Risk Factors

Domaines: Immunologie; Bactériologie; Virologie

A. Laurent, A. Klich, Pascal Roy, Bruno Lina, B. Kassai, et al.. Pediatric renal transplantation: A retrospective single-center study on epidemiology and morbidity due to EBV. Pediatric Transplantation, 2018, 22 (3), pp.e13151. ⟨10.1111/petr.13151⟩. ⟨hal-01917823⟩