title: Use of EBV PCR for the diagnosis and monitoring of post-transplant lymphoproliferative disorder in adult solid organ transplant patients.
abstract: Epstein-Barr virus (EBV) is known to be involved in the majority of patients who develop post-transplant lymphoproliferative disorder after solid organ transplant. We conducted a retrospective study to determine the utility of qualitative and quantitative Epstein-Barr virus polymerase chain reaction (PCR) for the diagnosis and monitoring of post-transplant lymphoproliferative disorder in adult solid organ transplant patients. Peripheral blood leukocytes obtained from 35 adult solid organ transplant patients consecutively referred for evaluation of possible post-transplant lymphoproliferative disorder, were tested by EBV PCR at the time of initial evaluation and at time points thereafter. Eighteen of 35 (51%) patients were ultimately diagnosed with post-transplant lymphoproliferative disorder by tissue biopsy. Fifteen of 18 (83%) patients were found to have EBER-1 positive tumors by in situ hybridization. EBV PCR was positive in 7 of 15 patients, suggesting a sensitivity of 39%. Seventeen patients without post-transplant lymphoproliferative disorder and three with EBER-1 negative post-transplant lymphoproliferative disorder all had negative EBV PCR tests, suggesting a specificity of 100%. We observed that declines in EBV DNA load were associated with response to therapeutic interventions, such as reduction in immunosuppression, rituximab therapy and chemotherapy. We conclude that peripheral blood EBV PCR may have a role in the diagnosis and monitoring of post-transplant lymphoproliferative disorder in adult solid organ transplant patients.
authors.affiliation: Hematologic Malignancies Program, University of Pennsylvania Cancer Center, Philadelphia, Pennsylvania 19104, USA. detsai@mail.med.upenn.edu
authors.forename: Donald E
authors.initials: DE
authors.lastname: Tsai
authors.forename: Monica
authors.initials: M
authors.lastname: Nearey
authors.forename: Christine L
authors.initials: CL
authors.lastname: Hardy
authors.forename: John E
authors.initials: JE
authors.lastname: Tomaszewski
authors.forename: Robert M
authors.initials: RM
authors.lastname: Kotloff
authors.forename: Robert A
authors.initials: RA
authors.lastname: Grossman
authors.forename: Kim M
authors.initials: KM
authors.lastname: Olthoff
authors.forename: Edward A
authors.initials: EA
authors.lastname: Stadtmauer
authors.forename: David L
authors.initials: DL
authors.lastname: Porter
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Schuster
authors.forename: Selina M
authors.initials: SM
authors.lastname: Luger
authors.forename: Richard L
authors.initials: RL
authors.lastname: Hodinka
mesh_terms: D000328:Adult; D000368:Aged; D020031:Epstein-Barr Virus Infections / Q000175:diagnosis* / Q000453:epidemiology; D005260:Female; D004854:Herpesvirus 4, Human / Q000235:genetics / Q000302:isolation & purification*; D006801:Humans; D016030:Kidney Transplantation; D016031:Liver Transplantation; D008232:Lymphoproliferative Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000821:virology*; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D010414:Pennsylvania; D016133:Polymerase Chain Reaction / Q000379:methods; D011183:Postoperative Complications / Q000821:virology*; D044469:Racial Groups; D015203:Reproducibility of Results; D012189:Retrospective Studies; D014180:Transplantation