Epstein–Barr virus status and immunosuppression use in paediatric autoimmune liver disease

• DOI: 10.1111/apt.16708
• Publication Date: 2021-11-19T04:36:55Z
• Authors: Jeremy S. Nayagam; Michael A. Heneghan; Marianne Samyn; Deepak Joshi
• Keywords: Immunosuppression; Autoimmune Hepatitis; Lymphoproliferative Disorders

Summary Background Since azathioprine is associated with lymphoproliferative disorders in Epstein–Barr virus (EBV)‐naïve patients inflammatory bowel disease, guidelines advise avoidance. No recommendations exist for autoimmune liver disease (AILD). Aims To evaluate EBV status and EBV‐related complications paediatric AILD. Methods Single‐centre, retrospective, observational study of Results In 245 AILD, was used 168 (68.6%) mycophenolate mofetil 69 (28.2%). assessed 18 (10.7%) prior to 6 (8.7%) MMF. Acute infection diagnosed five while on immunosuppression, resulting one transient hepatitis persistent hepatitis. There were no cases disorder native livers. Liver transplantation (LT) performed 39 (15.9%) patients, 8 IgG‐negative at LT. Post‐LT viraemia developed 29 (74.4%), first detected median 26 days (IQR, 13‐86). recipients had higher peak (266 984 IU/mL [IQR, 41108‐2429050] v 5333 2036‐38770], P = .004) longer time (375 251‐884] 70 21‐604], .04). Early EBV‐associated post‐transplant (PTLD) two both EBV‐IgG negative azathioprine. Conclusions Real‐world data demonstrate that serostatus not routinely checked before immunosuppression Lymphoproliferative those livers; however, LT receiving IgG‐positive donor organs are risk early PTLD. Large multicentre studies follow‐up required further the risk.