Chronic High Epstein-Barr Viral Load Carriage Is Positively Correlated With Tacrolimus Intra-Patient Variability After Pediatric Liver Transplantation

Abstract

Chronic high Epstein-Barr virus (EBV) load (CHL) carriage has been closely associated with EBV infection after pediatric liver transplantation. Elevated tacrolimus (Tac) blood concentrations increased the risk of EBV-associated diseases. Tacrolimus intra-patient variability (Tac-IPV) help predict poor outcomes. This study examines whether Tac-IPV correlate with CHL carriage in living-donor-dominant pediatric liver transplantation. We analyzed the clinical data of 153 pediatric liver transplant recipients receiving Tac treatment with a 2-year follow-up period. Tac-IPV quantification as coefficient of variation (CV). CHL was defined as EBV DNA > 16,000 copies/mL in whole blood or > 200 copies/10⁵ peripheral blood mononuclear cells in ≥ 50% of samples over 6 months. The results showed that 81 cases (52.94%) of recipients developed CHL after liver transplantation. CV-IPV (OR = 1.034, 95% CI: 1.006–1.063, p = 0.019) was an independent risk factor for CHL carriage. Additional risk factors included younger age, absence of mycophenolate mofetil use, and earlier timing of first EBV viremia. In conclusion, CHL carriage development in pediatric liver transplant recipients is positively correlated with Tac-IPV.