Epstein–Barr virus-associated post-transplant lymphoproliferative disorders in pediatric transplantation: A prospective multicenter study in the United States

Abstract

Background: Epstein–Barr virus (EBV)-associated post-transplant lymphoproliferative disorders (PTLD) is the most common malignancy in children after transplant; however, difficulties for early detection may worsen the prognosis. Methods: The prospective, multicenter, study enrolled 944 children (≤21 years of age). Of these, 872 received liver, heart, kidney, intestinal, or multivisceral transplants in seven US centers between 2014 and 2019 (NCT02182986). In total, 34 pediatric EBV+ PTLD (3.9%) were identified by biopsy. Variables included sex, age, race, ethnicity, transplanted organ, EBV viral load, pre-transplant EBV serology, immunosuppression, response to chemotherapy and rituximab, and histopathological diagnosis. Results: The uni−/multivariable competing risk analyses revealed the combination of EBV-seropositive donor and EBV-naïve recipient (D+R−) was a significant risk factor for PTLD development (sub-hazard ratio: 2.79 [1.34–5.78], p =.006) and EBV DNAemia (2.65 [1.72–4.09], p