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Epstein‐Barr virus and persistent graft dysfunction after liver transplantation
Author(s) -
Telenti Amadlo,
Smith Thomas F.,
Ludwig Jurgen,
Keating Michael R.,
Krom Rund A. F.,
Wiesner Russell H.
Publication year - 1991
Publication title -
hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.488
H-Index - 361
eISSN - 1527-3350
pISSN - 0270-9139
DOI - 10.1002/hep.1840140213
Subject(s) - epstein–barr virus , virus , epstein–barr virus infection , gammaherpesvirinae , herpesviridae , liver transplantation , medicine , virology , transplantation , polymerase chain reaction , liver biopsy , seroconversion , lymphoma , pathology , immunology , hepatitis b virus , biopsy , biology , viral disease , biochemistry , gene
Epstein‐Barr virus infection has been associated with a broad spectrum of clinical manifestations, depending on the immune status of the host. In this report, we describe two liver transplant patients who received hepatic allografts from donors serologically positive for Epstein‐Barr virus and who experienced primary infection with Epstein‐Barr virus associated with prolonged liver graft dysfunction. In both patients, Epstein‐Barr serologies converted within 3 mo of liver transplantation, and hepatic histological study revealed mononuclear infiltration of the sinusoids evolving to pronounced immunoblastic features suggestive of evolving lymphoma. In both cases, in situ hybridization studies confirmed the presence of Epstein‐Barr virus genome in the liver. Furthermore, polymerase chain reaction analysis suggested that high levels of Epstein‐Barr virus DNA were present in biopsy specimens obtained during the episode of acute hepatitis that followed Epstein‐Barr virus seroconversion. The degree of Epstein‐Barr virus DNA estimated by polymerase chain reaction appeared to increase in parallel with the progression of parenchymal lymphocytic infiltrates. In one patient, a biopsy sample from a cervical node also revealed high levels of Epstein‐Barr virus DNA estimated using the polymerase chain reaction technique. Furthermore, in these patients, Epstein‐Barr virus DNA levels appeared to decrease dramatically after discontinuing azathioprine administration and beginning treatment with acyclovir. These two cases illustrate the dynamics of Epstein‐Barr virus immune regulation and confirm chronic hepatic allograft dysfunction related to Epstein‐Barr viral infection. (HEPATOLOGY 1991;14:282–286.)