The IPTA Nashville Consensus Conference on Post-Transplant lymphoproliferative disorders after solid organ transplantation in children: III - Consensus guidelines for Epstein-Barr virus load and other biomarker monitoring.

IF 1.2 4区 医学 Q3 PEDIATRICS Pediatric Transplantation Pub Date : 2024-02-01 Epub Date: 2023-06-09 DOI:10.1111/petr.14471
Jutta Preiksaitis, Upton Allen, Catherine M Bollard, Vikas R Dharnidharka, Daniel E Dulek, Michael Green, Olivia M Martinez, Diana M Metes, Marian G Michaels, Françoise Smets, Richard E Chinnock, Patrizia Comoli, Lara Danziger-Isakov, Anne I Dipchand, Carlos O Esquivel, Judith A Ferry, Thomas G Gross, Robert J Hayashi, Britta Höcker, Arnaud G L'Huillier, Stephen D Marks, George Vincent Mazariegos, James Squires, Steven H Swerdlow, Ralf U Trappe, Gary Visner, Steven A Webber, James D Wilkinson, Brtitta Maecker-Kolhoff
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Abstract

The International Pediatric Transplant Association convened an expert consensus conference to assess current evidence and develop recommendations for various aspects of care relating to post-transplant lymphoproliferative disorders after solid organ transplantation in children. In this report from the Viral Load and Biomarker Monitoring Working Group, we reviewed the existing literature regarding the role of Epstein-Barr viral load and other biomarkers in peripheral blood for predicting the development of PTLD, for PTLD diagnosis, and for monitoring of response to treatment. Key recommendations from the group highlighted the strong recommendation for use of the term EBV DNAemia instead of "viremia" to describe EBV DNA levels in peripheral blood as well as concerns with comparison of EBV DNAemia measurement results performed at different institutions even when tests are calibrated using the WHO international standard. The working group concluded that either whole blood or plasma could be used as matrices for EBV DNA measurement; optimal specimen type may be clinical context dependent. Whole blood testing has some advantages for surveillance to inform pre-emptive interventions while plasma testing may be preferred in the setting of clinical symptoms and treatment monitoring. However, EBV DNAemia testing alone was not recommended for PTLD diagnosis. Quantitative EBV DNAemia surveillance to identify patients at risk for PTLD and to inform pre-emptive interventions in patients who are EBV seronegative pre-transplant was recommended. In contrast, with the exception of intestinal transplant recipients or those with recent primary EBV infection prior to SOT, surveillance was not recommended in pediatric SOT recipients EBV seropositive pre-transplant. Implications of viral load kinetic parameters including peak load and viral set point on pre-emptive PTLD prevention monitoring algorithms were discussed. Use of additional markers, including measurements of EBV specific cell mediated immunity was discussed but not recommended though the importance of obtaining additional data from prospective multicenter studies was highlighted as a key research priority.

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IPTA 纳什维尔儿童实体器官移植后淋巴组织增生性疾病共识会议:III--Epstein-Barr病毒载量和其他生物标志物监测共识指南。
国际儿科移植协会召开了一次专家共识会议,以评估现有证据,并就儿童实体器官移植后淋巴组织增生性疾病的各方面护理提出建议。在病毒载量和生物标记物监测工作组的这份报告中,我们回顾了有关外周血中 Epstein-Barr 病毒载量和其他生物标记物在预测 PTLD 的发生、PTLD 诊断和治疗反应监测中的作用的现有文献。工作组提出的主要建议强调,强烈建议使用EBV DNA血症一词而不是 "病毒血症 "来描述外周血中的EBV DNA水平,并关注不同机构进行的EBV DNA血症测量结果的比较问题,即使检测结果是用世界卫生组织的国际标准校准的。工作组认为,全血或血浆均可作为 EBV DNA 测量的基质;最佳标本类型可能取决于临床情况。全血检测在监测方面具有一定优势,可为预防性干预措施提供依据,而在临床症状和治疗监测方面,血浆检测可能是首选。不过,不建议仅用EBV DNA血症检测来诊断PTLD。建议对移植前EBV血清阴性的患者进行EBV DNA血症定量监测,以确定PTLD的高危患者,并为预防性干预措施提供依据。与此相反,除了肠道移植受者或在 SOT 之前最近感染过原发性 EBV 的患者外,不建议对移植前 EBV 血清阳性的儿科 SOT 受者进行监测。会议讨论了病毒载量动力学参数(包括峰值载量和病毒设定点)对先期PTLD预防监测算法的影响。会议讨论了其他标记物的使用,包括 EBV 特异性细胞介导免疫的测量,但不建议使用这些标记物,不过会议强调了从前瞻性多中心研究中获取更多数据的重要性,认为这是一项关键的优先研究事项。
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来源期刊
Pediatric Transplantation
Pediatric Transplantation 医学-小儿科
CiteScore
2.90
自引率
15.40%
发文量
216
审稿时长
3-8 weeks
期刊介绍: The aim of Pediatric Transplantation is to publish original articles of the highest quality on clinical experience and basic research in transplantation of tissues and solid organs in infants, children and adolescents. The journal seeks to disseminate the latest information widely to all individuals involved in kidney, liver, heart, lung, intestine and stem cell (bone-marrow) transplantation. In addition, the journal publishes focused reviews on topics relevant to pediatric transplantation as well as timely editorial comment on controversial issues.
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