title: Monitoring infection with Epstein-Barr virus among seromismatch adult renal transplant recipients.
abstract: Patients who undergo Epstein-Barr virus (EBV) seromismatch (D+/R-) transplants have a higher risk for the development of post-transplant lymphoproliferative disorder (PTLD). Adult renal transplant recipients at a single institution were prospectively monitored for EBV during the first year post-transplant. Over a 2-year period, 34 patients (7.78%) were identified as being EBV D+/R-recipients. Patients who developed symptoms or had persistent viremia were pre-emptively administered rituximab. Six recipients were discharged without monitoring on the protocol. Of those six, three (50%) developed PTLD and all three lost their grafts. Twenty (60.6%) of the 34 recipients developed viremia during the first year post-transplant. Of the recipients who became viremic, six (30%) received rituximab. None of the six who received rituximab-developed PTLD. We found that recipients who were not monitored on the protocol were more likely to have PTLD and graft loss compared to those who were (p = 0.008). Post-transplant monitoring of adults who undergo EBV D+/R-kidney transplants for viremia and symptoms associated with EBV infection may prompt intervention which reduces the incidence of PTLD within the first year. Use of rituximab in preventing PTLD among patients with primary EBV infection requires further prospective study to determine its overall safety and efficacy.
authors: Division of Infectious Diseases and The Comprehensive Transplant Center, The Ohio State University Medical Center, Columbus, OH, USA. stanley.martin@osumc.edu
authors: S I
authors: SI
authors: Martin
authors: B
authors: B
authors: Dodson
authors: C
authors: C
authors: Wheeler
authors: J
authors: J
authors: Davis
authors: T
authors: T
authors: Pesavento
authors: G L
authors: GL
authors: Bumgardner
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D058846:Antibodies, Monoclonal, Murine-Derived / Q000627:therapeutic use; D020031:Epstein-Barr Virus Infections / Q000378:metabolism*; D005260:Female; D004854:Herpesvirus 4, Human / Q000378:metabolism*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016030:Kidney Transplantation / Q000379:methods*; D008232:Lymphoproliferative Disorders / Q000188:drug therapy / Q000821:virology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012306:Risk; D000069283:Rituximab; D019562:Viral Load
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D007166:Immunosuppressive Agents; D000069283:Rituximab