title: Epstein-Barr virus infection in heart and heart-lung transplant recipients: incidence and clinical impact.
abstract: BACKGROUND
  A retrospective serologic study was made of 67 heart-lung and 295 heart transplant recipients (with transplantations at Papworth Hospital, Cambridge, England) to determine the incidence and clinical impact of Epstein-Barr virus infection.
  
  
  METHODS
  Epstein-Barr virus capsid antigen immunofluorescence tests were performed, and the antibody avidity was determined by modifying the washing procedure to include a mild reducing agent (8M urea).
  
  
  RESULTS
  This testing showed that 6.0% of the patients had primary Epstein-Barr virus infections, whereas 17.4% had the reactivation of a past infection. Primary infections were only detected in patients who were Epstein-Barr virus antibody-negative before transplantation, who had received an organ from an Epstein-Barr virus antibody-positive donor. Of the patients with serologically proven Epstein-Barr virus infections, 52.9% had symptoms. Although these were generally mild, five heart and two heart-lung transplant recipients had malignant lymphoma and one heart and one heart-lung transplant recipient had lymphoproliferative disease after Epstein-Barr virus infection. Additional four heart transplant recipients had lymphoma after transplantation. None of these four patients had evidence of active Epstein-Barr virus infection; one was Epstein-Barr virus antibody-negative during the study period and three had stable Epstein-Barr virus virus capsid antigen immunoglobulin G titers throughout.
  
  
  CONCLUSIONS
  Epstein-Barr virus infection in organ transplant recipients may lead on to life-threatening lymphoproliferative disease or lymphoma. For this reason it may be beneficial to monitor patients after transplantation for evidence of Epstein-Barr virus infection and to follow the progress of those affected.
authors.affiliation: Department of Clinical Microbiology, Addenbrooke's Hospital, Cambridge, United Kingdom.
authors.forename: J
authors.initials: J
authors.lastname: Gray
authors.forename: T G
authors.initials: TG
authors.lastname: Wreghitt
authors.forename: P
authors.initials: P
authors.lastname: Pavel
authors.forename: R L
authors.initials: RL
authors.lastname: Smyth
authors.forename: J
authors.initials: J
authors.lastname: Parameshwar
authors.forename: S
authors.initials: S
authors.lastname: Stewart
authors.forename: N
authors.initials: N
authors.lastname: Cary
authors.forename: S
authors.initials: S
authors.lastname: Large
authors.forename: J
authors.initials: J
authors.lastname: Wallwork
mesh_terms: D000293:Adolescent; D000328:Adult; D000914:Antibodies, Viral / Q000097:blood; D000956:Antigens, Viral / Q000097:blood; D036022:Capsid Proteins; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D016027:Heart Transplantation / Q000276:immunology*; D016041:Heart-Lung Transplantation / Q000276:immunology*; D004854:Herpesvirus 4, Human / Q000276:immunology*; D006801:Humans; D007223:Infant; D007244:Infectious Mononucleosis / Q000175:diagnosis / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D009894:Opportunistic Infections / Q000175:diagnosis / Q000276:immunology*; D011183:Postoperative Complications / Q000175:diagnosis / Q000276:immunology*; D012189:Retrospective Studies; D014775:Virus Activation / Q000276:immunology
chemical_list: D000914:Antibodies, Viral; D000956:Antigens, Viral; D036022:Capsid Proteins; C041788:Epstein-Barr viral capsid antigen