title: Impact of Epstein-Barr virus donor and recipient serostatus on the incidence of post-transplant lymphoproliferative disorder in kidney transplant recipients.
abstract: BACKGROUND
  Post-transplant lymphoproliferative disorder (PTLD) is a serious complication of transplantation.
  
  
  METHODS
  Using the OPTN/UNOS database, primary kidney recipients (2000-2009) were stratified according to transplant type (deceased donor, DD or living donor, LD), donor (D) and recipient (R) Epstein-Barr virus (EBV) serostatus (R+; D+/R- and D-/R-) and recipient age. Incidence and adjusted risk of PTLD and death were compared.
  
  
  RESULTS
  Of the 137 939 primary kidney recipients transplanted between 2000 and 2009, 913 subsequently developed PTLD. In 90 208 recipients with known EBV serostatus, we found a trend toward a decrease in PTLD incidence in years 2007-2009 when compared to 2000-2003. This was due to a significant decrease in PTLD incidence in EBV- recipients. Of those, 61 273 had a known donor serostatus and were further examined. In adults, PTLD incidence (in 1000 person-years) in DD and LD was 7.0 and 7.0 in D+/R-; 3.0 and 2.5 in D-/R- and 1.2 and 1.0 in R+, respectively. The hazard ratio (HR) for PTLD (R+ as reference) in D+/R- (6.2 in DD and 7.2 in LD) was double to thrice than for D-/R- transplants (2.4 in both DD and LD). In pediatric recipients, PTLD incidence in DD and LD was 15.9 and 17.3 in D+/R-; 12 and 18 in D-/R- and 1.2 and 2.2 in R+, respectively. The HR for PTLD was 17.4 and 6.9 in D+/R- and 15.9 and 7.6 in D-/R- in DD and LD, respectively.
  
  
  CONCLUSIONS
  A D+/R-, compared with a D-/R- transplant, may contribute to an increase in PTLD incidence of 35 and 42% in adult DD and LD transplants, respectively.
authors.affiliation: Mendez National Institute of Transplantation, Los Angeles, CA, USA. sampaioms@hotmail.com
authors.forename: Marcelo Santos
authors.initials: MS
authors.lastname: Sampaio
authors.forename: Yong W
authors.initials: YW
authors.lastname: Cho
authors.forename: Tariq
authors.initials: T
authors.lastname: Shah
authors.forename: Suphamai
authors.initials: S
authors.lastname: Bunnapradist
authors.forename: Ian V
authors.initials: IV
authors.lastname: Hutchinson
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D020031:Epstein-Barr Virus Infections / Q000097:blood / Q000821:virology; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006084:Graft Rejection / Q000188:drug therapy* / Q000209:etiology; D006085:Graft Survival; D004854:Herpesvirus 4, Human; D006801:Humans; D015994:Incidence; D016030:Kidney Transplantation / Q000009:adverse effects*; D015141:Los Angeles / Q000453:epidemiology; D008232:Lymphoproliferative Disorders / Q000097:blood* / Q000453:epidemiology* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011379:Prognosis; D051436:Renal Insufficiency, Chronic / Q000150:complications* / Q000401:mortality / Q000601:surgery; D055502:Secondary Prevention; D015996:Survival Rate; D014019:Tissue Donors; D055815:Young Adult