Association between elevated whole blood Epstein-Barr virus (EBV)-encoded RNA EBV polymerase chain reaction and reduced incidence of acute lung allograft rejection.
BACKGROUND
Accurate functional assessment of patient immunosuppression after solid-organ transplantation remains elusive. Despite therapeutic serum immunosuppressive drug levels many lung transplant recipients still develop allograft rejection. We investigated the hypothesis that detection of latent Epstein-Barr virus (EBV) in peripheral blood may be a functional marker for the net effects of administered immunosuppression.


METHODS
A retrospective analysis was performed on data obtained from a prospective trial investigating the ability of a novel EBV polymerase chain reaction (PCR) panel for LMP (latent membrane protein 1), EBNA (EBV nuclear antigen) and EBER (EBV-encoded RNA) to predict future development of post-transplant lymphoproliferative disorder (PTLD). Thirty-one lung transplant patients were followed for up to 2 years after transplantation with EBV PCR panels performed on plasma and whole blood. Patients were assessed for occurrences of Grade 2 or higher acute rejection and episodes of infection.


RESULTS
Patients with whole blood EBER-positive PCR had a statistically significant lower incidence (45% vs 83%) of Grade 2 or higher acute allograft rejection than patients with no positive assays (odds ratio [OR] = 0.17, 95% confidence interval [CI] 0.021 to 1.2, p = 0.048). Positive whole blood EBER PCR did not correlate with increased risk for infectious complications (OR = 1.6, 95% CI 0.22 to 11, p = 0.69).


CONCLUSIONS
These results suggest that whole blood EBER EBV PCR load may represent an important functional measure of immunosuppression in solid-organ transplant patients.
Ahya
Vivek N
VN
Pulmonary, Allergy, and Critical Care Division, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania 19104, USA. ahyav@uphs.upenn.edu <ahyav@uphs.upenn.edu>
Douglas
Lisa P
LP
Andreadis
Charalambos
C
Arnoldi
Sharon
S
Svoboda
Jakub
J
Kotloff
Robert M
RM
Hadjiliadis
Denis
D
Sager
Jeffery S
JS
Woo
Y Joseph
YJ
Pochettino
Alberto
A
Schuster
Stephen J
SJ
Stadtmauer
Edward A
EA
Tsai
Donald E
DE
D000208:Acute Disease; D001999:Bronchoscopy; D020031:Epstein-Barr Virus Infections / Q000150:complications / Q000188:drug therapy / Q000821:virology*; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D004854:Herpesvirus 4, Human / Q000235:genetics* / Q000302:isolation & purification; D006801:Humans; D007165:Immunosuppression Therapy / Q000009:adverse effects*; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use; D015994:Incidence; D016040:Lung Transplantation; D009657:North Carolina / Q000453:epidemiology; D009864:Ontario / Q000453:epidemiology; D016133:Polymerase Chain Reaction; D011379:Prognosis; D012367:RNA, Viral / Q000097:blood / Q000235:genetics* / Q000276:immunology; D012189:Retrospective Studies; D012720:Severity of Illness Index; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D019562:Viral Load
D007166:Immunosuppressive Agents; D012367:RNA, Viral