Utility of semiquantitative polymerase chain reaction for Epstein-Barr virus to measure virus load in pediatric organ transplant recipients with and without posttransplant lymphoproliferative disease

We examined the utility of Epstein-Barr virus (EBV) load as a test for the presence of posttransplant lymphoproliferative disease (PTLD). A semiquantitative (SQ) EBV polymerase chain reaction (PCR) on peripheral blood mononuclear cells (PBMC) was used to determine virus load. We compared the values from pediatric patients, both with and without PTLD, with those from healthy pediatric and adult subjects. The virus loads for asymptomatic healthy subjects had a range of 0-1 log(10) cells/10(6) PBMCs. Among transplant recipients (n = 135), the mean virus load (+/- standard deviation) at the time of diagnosis of PTLD was 3.1 +/- 1.2 log(10) cells/10(6) PBMCs versus a baseline value of 1.3 +/- 1.4 log(10) cells/10(6) PBMCs in children without PTLD (P < .0001). A cutoff of <greater than or equal to>3 log(10) cells/10(6) peripheral blood leukocytes resulted in the following values for use of virus load as a test for PTLD: sensitivity, 69%; specificity, 76%; positive predictive value, 28%; and negative predictive value, 95%. We conclude that determination of EBV load by use of SQ PCR is more useful in ruling out than in indicating the presence of PTLD.