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Epstein-Barr Virus as a Cause of Cancer in Recipients of Kidney Transplantation
About 90% of U.S. adults are seropositive for Epstein-Barr Virus (EBV); thus, organ transplants between seropositive donors and seronegative recipients (EBV D+/R−) are uncommon. Furthermore, such recipients are at increased risk for post-transplant lymphoproliferative disease (PTLD). What is the magnitude of that risk?
In a retrospective cohort study, investigators matched 104 high-risk (EBV D+/R−) adults to 312 low-risk (EBV R+) adults who had received kidney transplants. Most recipients underwent induction immunosuppression with thymoglobulin. During the 3-year post-transplant follow-up period, PTLD developed in 22% of high-risk patients a median 202 days after transplant. No cases were identified among EBV R+ or D−/R− individuals. EBV D+/R− status was significantly associated with graft failure (hazard ratio, 2.21); risk for death was also higher (HR, 2.19), but not statistically significantly so.
Comment
PTLD is a significant cause of death in solid organ transplant recipients, and the one-in-five chances of developing this cancer in high-risk patients emphasizes the need for preventive strategies and rigorous diagnostic efforts whenever symptoms suggest PTLD. Accordingly, we monitor EBV DNA in blood samples (an indicator of viral load) frequently in our high-risk patients and modulate immunosuppression as appropriate, even though data are scant to guide this approach. We eagerly await prospective studies of preventive approaches such as EBV vaccines given before transplant.
Citation(s)
Author:
Potluri VS et al.
Title:
The association of Epstein–Barr virus donor and recipient serostatus with outcomes after kidney transplantation: A retrospective cohort study.
Source:
Ann Intern Med
2025
Jan
28; [e-pub].
(Abstract/FREE Full Text)
Empfohlen von
Daniel Kaul, MD