Kinetics and Clinical Outcomes of EBV DNAemia in Whole Blood and Plasma Among Pediatric Liver Transplant Recipients: A Single-center Experience

Background. Data on the course of Epstein-Barr virus (EBV) DNAemia are limited in the pediatric liver transplant (LT) setting. This study aims to analyze the kinetics and clinical outcomes of EBV DNAemia in whole blood (WB) and plasma, and to evaluate the incidence and risk factors for EBV DNAemia, chronic high EBV load (CHL) carriage, and posttransplant lymphoproliferative disorder (PTLD). Methods. A retrospective analysis of longitudinal EBV DNAemia and clinical data from 237 children undergoing LT between April 2014 and May 2022 was performed. EBV DNAemia was measured in WB, switching to plasma on September 1, 2018. There was a 20-mo transitional period, during which both matrices were used. Results. CHL occurred in 23 (22.1%) patients monitored in WB. Peak EBV DNAemia and EBV DNAemia exposure (measured as the area under the concentration-time curve) >1 y post-LT were higher in PTLD cases, regardless of the matrix used. Among CHL carriers, 21.7% (5/23) developed PTLD. In age-adjusted analyses, cytomegalovirus (CMV) DNAemia within 1 y post-LT was associated with EBV DNAemia (relative risk [RR], 1.16; P = 0.026). CHL carriage was associated with CMV DNAemia within 1 y post-LT (RR, 2.33; P = 0.044), EBV donor-positive/recipient-negative (D+/R–: RR, 3.62; P = 0.036), ABO-incompatible graft (RR, 3.03; P < 0.001), and early EBV DNAemia (<6 mo: RR, 3.46; P = 0.030). PTLD development was associated with early EBV DNAemia (<6 mo: RR, 3.58; P = 0.022) and CMV D+/R– (RR, 2.49; P = 0.030). Conclusions. The study provides longitudinal data on EBV DNAemia in the context of CHL and PTLD. Prospective studies are warranted to validate the identified factors associated with EBV-related outcomes.