Background: Epstein-Barr virus (EBV) infection is associated with post-transplant lymphoproliferative disorder (PTLD), therefore EBV serological tests are essential part of routine followup of pediatric liver transplant recipients (PLTR). EBV serology consists of viral capsid antigen (VCA) IgG, VCA IgM and EBV nuclear antigen (EBNA) IgG. Those serological tests might be distorted in chronic and immunosuppressed patients. Since the introduction of EBV viral load assays which provide accurate monitoring tool for follow up of solid organ transplants, clinical implication of EBV serology remains unclear.
Objective: Description of EBV serological pattern among PLTR with EBV infection approved by real-time viral load PCR.
Methods: Data of PLTR in Israel between 2004 and 2016 was reviewed. EBV serology was collected in all patients with detectable viral load measurement by PCR. Changes in EBV serology were correlated to the time of EBV viremia proved by PCR.
Results: Positive EBV viral load detected by real-time PCR was found in 61 PLTR. In 24.5% patients IgG EBNA antibodies remained negative, although EBV infection or reinfection was proved by EBV viral load assay. In 15 patients IgG EBNA antibodies changed from positive to negative during follow up time. In a minority of 3% of liver transplant recipients, no VCA-IgG were detected. No PTLD cases were found in patients with negative EBNA serology.
Conclusions: While positive EBNA IgG results can reflect past EBV infection, negative EBNA IgG does not exclude previous EBV viremia in PLTR. Some transplanted patients might not have any serological marker of EBV infection. EBV serology has very limited value in PLTR. Our findings support using EBV viral load assays as the main diagnostic test for PLTR follow up.
