title: Post-transplant lymphoproliferative disorders and Epstein-Barr virus DNAemia in a cohort of lung transplant recipients.
abstract: BACKGROUND
  Post-transplant lymphoproliferative disorders (PTLD) are serious complications in lung transplant recipients. No consensus on EBV DNAemia levels predictive of PTLD has been reached. In addition, in many instances EBV DNAemia is determined in patients with suggestive symptoms only.
  
  
  METHODS
  The characteristics of five patients with PTLD as well as the prevalence of EBV DNAmia in a cohort of 137 consecutive patients receiving lung transplantation are described.
  
  
  RESULTS
  Twenty-six out of 137 patients (18.9%) were excluded from the analysis because lost at follow-up or dead from PTLD-independent reasons within three months of transplantation. EBV DNA in peripheral blood mononuclear cells (PBMC) was determined in 83/111 patients (74.8%) because of potential PTLD-related symptoms, while 28 patients (25.2%) showed no symptoms and were not examined. EBV DNAemia was positive in 53/83 patients (63.8%), and negative in 30/83 patients (36.2%). PTLD was diagnosed in five (4.5%) patients at a median time of 270 (range 120-870) days following transplantation. All five PTLD (three large B-cell lymphomas, one Hodgkin lymphoma and one possible pre-neoplastic lesion) were potentially associated with EBV infection. However, only 3/5 patients with PTLD had detectable EBV DNAemia: < 1,000 copies EBV DNA/1 × 10⁵ PBMC in one patient and > 1,000 copies EBV DNA/1 × 10⁵ PBMC in two patients.
  
  
  CONCLUSIONS
  A systematic multidisciplinary (clinical, radiologic, virologic and histologic) approach is mandatory for the diagnosis and management of PTLD in lung transplant recipients, while monitoring of symptomatic patients only may provide an incomplete or late picture of the clinical problem. In addition, staining for EBV antigens and quantification of EBV DNA in biopsy specimens should always be performed to understand the role of EBV infection in the pathogenesis of PTLD.
authors: Laboratori Sperimentali di Ricerca, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy. f.baldanti@smatteo.pv.it
authors: Fausto
authors: F
authors: Baldanti
authors: Vanina
authors: V
authors: Rognoni
authors: Alessandro
authors: A
authors: Cascina
authors: Tiberio
authors: T
authors: Oggionni
authors: Carmine
authors: C
authors: Tinelli
authors: Federica
authors: F
authors: Meloni
mesh_terms: D000328:Adult; D000369:Aged, 80 and over; D015331:Cohort Studies; D016172:DNA Fingerprinting; D004279:DNA, Viral / Q000032:analysis*; D020031:Epstein-Barr Virus Infections / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology / Q000821:virology; D005260:Female; D005500:Follow-Up Studies; D004854:Herpesvirus 4, Human / Q000235:genetics* / Q000276:immunology; D006801:Humans; D007558:Italy; D007963:Leukocytes, Mononuclear / Q000276:immunology / Q000821:virology; D016040:Lung Transplantation / Q000009:adverse effects* / Q000276:immunology; D008232:Lymphoproliferative Disorders / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology / Q000821:virology; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction / Q000379:methods*; D019562:Viral Load / Q000276:immunology
chemical_list: D004279:DNA, Viral