Anti-viral prophylaxis reduces the incidence of lymphoproliferative disease in lung transplant recipients.
BACKGROUND
Post-transplant lymphoproliferative disease (PTLD) is a serious, often fatal complication after solid organ transplantation. Primary Epstein-Barr virus (EBV) infection is the major risk factor for PTLD after lung transplantation, with 30% to 50% of EBV-naive patients who seroconvert and are diagnosed with PTLD.


METHODS
In this study, we analyzed the incidence of PTLD in lung and heart-lung transplant recipients before 1996 (historic group) and then compared the impact of long-term anti-viral prophylaxis on the development of PTLD in EBV-seronegative recipients from January 1996 to December 2000 (post-1996 group). Routine induction therapy was not given after 1995. Patients not surviving 30 days, 25 of 341 (7.3%), were excluded.


RESULTS
Historic group: PTLD developed in 7 of 167 (4.2%) patients, at a mean of 394 +/- 278 (95-885) days. The mortality was 87.5% at a mean follow-up of 186 +/- 207 (17-520) days after diagnosis. Post-1996 group: Eighteen of 149 (12.3%) patients were EBV seronegative at the time of transplantation, and of these 15 (83%) began receiving continuous anti-viral prophylaxis: acyclovir or valacyclovir or ganciclovir from January 1996. None of the EBV-seronegative recipients receiving continuous anti-viral prophylaxis were diagnosed with PTLD; however, 1 of 3 (33%) of the EBV-seronegative recipients who did not receive anti-viral prophylaxis were diagnosed with PTLD. In the EBV-seronegative recipients, no deaths had been caused by PTLD at a mean follow-up of 806 +/- 534 (39-1,084) days. In the post-1996 group, PTLD developed in 1 of 131 (0.76%) EBV-seropositive recipients.


CONCLUSIONS
Continuous, specific anti-viral prophylaxis in high-risk EBV-seronegative recipients significantly reduces the incidence of PTLD after lung transplantation in the absence of induction therapy.
Malouf
Monique A
MA
Lung Transplant Unit, St. Vincent's Hospital, Darlinghurst, Sydney, Australia. mmalouf@stvincents.com.au
Chhajed
Prashant N
PN
Hopkins
Peter
P
Plit
Marshall
M
Turner
Jenny
J
Glanville
Allan R
AR
D000212:Acyclovir / Q000031:analogs & derivatives* / Q000627:therapeutic use*; D000328:Adult; D000914:Antibodies, Viral / Q000032:analysis; D000998:Antiviral Agents / Q000627:therapeutic use*; D005260:Female; D004854:Herpesvirus 4, Human / Q000276:immunology; D006801:Humans; D016040:Lung Transplantation; D008232:Lymphoproliferative Disorders / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D011292:Premedication / Q000379:methods*; D000077483:Valacyclovir; D014633:Valine / Q000031:analogs & derivatives* / Q000627:therapeutic use*
D000914:Antibodies, Viral; D000998:Antiviral Agents; D014633:Valine; D000077483:Valacyclovir; D000212:Acyclovir