#PedsTID time for virtual case conference @PIDSociety given by Dr. #AhmadHachem mentor @paulksue1 focusing on #EBV and #PTLD in organ transplant recipients - recording will be available pids.org/transplant-imm… 1/10 
Many good pearls here - of note, importance of PTLD as a post-transplant complication in pediatric organ transplantation - overall ped SOT 5 yr incidence 3-15% with 5 yr mortality 20-25%. 2/10
@AST_IDCOP guidelines for PTLD, EBV infection and disease in SOT important resource - note any sign/symptom concerning for PTLD should prompt evaluation with tissue biopsy = gold standard onlinelibrary.wiley.com/doi/full/10.11… 3/10
For EBV viremia alone without symptoms in SOT recipient, approach depends on patient risk assessment - if high risk recommend monitoring with pre-emptive therapy strategy. 4/10
Main risk factors for developing PTLD in SOT recipients include 1) developing primary EBV infection post-transplant, 2) high net state of immunosuppression (driven by organ type e.g. intestinal & lung transplant >> others), 3) earlier time post-transplant. 5/10
Across all organ transplant types, pediatric recipients have higher cumulative incidence of PTLD at 1 & 5 years vs. adults. 6/10
Another PTLD risk factor appreciated = high rate of rise of EBV DNAemia (>44,000 copies/ml/week). 7/10
Approaches to pre-emptive therapy in SOT recipients with EBV viremia with goal to prevent development of PTLD - the primary strategies are reduction of immunosuppression and administration of rituximab. 8/10
Importantly, conventional antiviral therapy unlikely to help EBV viremia in SOT. EBV is predominantly in latent infectious cycle, rather than lytic. Antivirals interrupt replication & thus affect lytic phase virus that is actively replicating, not latent. 9/10
With recognition of high risk scenario for PTLD, early detection of EBV DNAemia via monitoring, pre-emptive reduction in immunosuppression vs. rituximab depending on scenario, there is opportunity to interrupt progression to PTLD with favorable outcome. 9/10
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