Management of Epstein–Barr Virus Infection and Post-Transplant Lymphoproliferative Disorder in Pediatric Liver Transplantation
Tatsuya Okamoto, Hideaki Okajima, Elena Yukie Uebayashi, Eri Ogawa, Yosuke Yamada, Katsutsugu Umeda, Hidefumi Hiramatsu, Etsurou Hatano
Abstract
With the advancement of immunosuppressive strategies, the outcome of liver transplantation during childhood has dramatically improved. On the other hand, Epstein-Barr virus (EBV) infection and associated post-transplant lymphoproliferative diseases (PTLD), such as malignant lymphoma, are serious complications that contribute to morbidity and mortality, and are still an important issue today. Recently, an early diagnosis by quantitative PCR and PET-CT testing, and treatment with rituximab (an anti-CD20 antibody) has been established, and long-term remission has been achieved in many cases. However, the optimal immunosuppression protocol after remission of PTLD needs to be determined, and it is hoped that a treatment for refractory PTLD (e.g., PTL-NOS) will be proposed.