title: Epstein-Barr virus infection in adult renal transplant recipients.
abstract: Epstein-Barr virus (EBV) DNAemia in the first year posttransplantation has been studied extensively. There is a paucity of information on prevalence and sequelae of EBV infection in adult renal transplantation beyond the first year. This single-center study examines the relationship between EBV DNAemia and demographic, immunosuppressive, hematologic and infection-related parameters in 499 renal transplant recipients between 1 month and 33 years posttransplant. Participants were tested repeatedly for EBV DNAemia detection over 12 months and clinical progress followed for 3 years. Prevalence of DNAemia at recruitment increased significantly with time from transplant. In multivariate adjusted analyses, variables associated with DNAemia included EBV seronegative status at transplant (p = 0.045), non-White ethnicity (p = 0.014) and previous posttransplant lymphoproliferative disease (PTLD) diagnosis (p = 0.006), while low DNAemia rates were associated with mycophenolate mofetil use (p < 0.0001) and EBV viral capsid antigen positive Epstein-Barr nuclear antigen-1 positive serostatus at transplant (p = 0.044). Patient and graft survival, rate of kidney function decline and patient reported symptoms were not significantly different between EBV DNAemia positive and negative groups. EBV DNAemia is common posttransplant and increases with time from transplantation, but EBV DNAemia detection in low-risk (seropositive) patients has poor specificity as a biomarker for future PTLD risk.
authors.affiliation: Department of Renal Medicine, Central Manchester University Hospitals Foundation Trust, Manchester, UK.
authors.forename: M
authors.initials: M
authors.lastname: Morton
authors.forename: B
authors.initials: B
authors.lastname: Coupes
authors.forename: S A
authors.initials: SA
authors.lastname: Roberts
authors.forename: S L
authors.initials: SL
authors.lastname: Johnson
authors.forename: P E
authors.initials: PE
authors.lastname: Klapper
authors.forename: P J
authors.initials: PJ
authors.lastname: Vallely
authors.forename: M L
authors.initials: ML
authors.lastname: Picton
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000914:Antibodies, Viral / Q000276:immunology; D000956:Antigens, Viral / Q000276:immunology; D003430:Cross-Sectional Studies; D004279:DNA, Viral / Q000032:analysis* / Q000235:genetics; D020031:Epstein-Barr Virus Infections / Q000175:diagnosis* / Q000821:virology; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006085:Graft Survival; D004854:Herpesvirus 4, Human / Q000235:genetics / Q000302:isolation & purification; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000601:surgery*; D007677:Kidney Function Tests; D016030:Kidney Transplantation; D008232:Lymphoproliferative Disorders / Q000175:diagnosis* / Q000821:virology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D066027:Transplant Recipients; D055815:Young Adult
chemical_list: D000914:Antibodies, Viral; D000956:Antigens, Viral; D004279:DNA, Viral
keywords: Epstein-Barr virus; PTLD; immunosuppression; renal transplantation