title: Current preventive strategies and management of Epstein-Barr virus-related post-transplant lymphoproliferative disease in solid organ transplantation in Europe. Results of the ESGICH Questionnaire-based Cross-sectional Survey.
abstract: There is limited clinical evidence on the utility of the monitoring of Epstein-Barr virus (EBV) DNAemia in the pre-emptive management of post-transplant lymphoproliferative disease (PTLD) in solid organ transplant (SOT) recipients. We investigated current preventive measures against EBV-related PTLD through a web-based questionnaire sent to 669 SOT programmes in 35 European countries. This study was performed on behalf of the ESGICH study group from the European Society of Clinical Microbiology and Infectious Diseases. A total of 71 SOT programmes from 15 European countries participated in the study. EBV serostatus of the recipient is routinely obtained in 69/71 centres (97%) and 64 (90%) have access to EBV DNAemia assays. EBV monitoring is routinely used in 85.9% of the programmes and 77.4% reported performing pre-emptive treatment for patients with significant EBV DNAemia levels. Pre-emptive treatment for EBV DNAemia included reduction of immunosuppression in 50.9%, switch to mammalian target of rapamycin inhibitors in 30.9%, and use of rituximab in 14.5% of programmes. Imaging by whole-body 18-fluoro-deoxyglucose positron emission tomography (FDG-PET) is used in 60.9% of centres to rule out PTLD and complemented computer tomography is used in 50%. In 10.9% of centres, FDG-PET is included in the first-line diagnostic workup in patients with high-risk EBV DNAemia. Despite the lack of definitive evidence, EBV load measurements are frequently used in Europe to guide diagnostic workup and pre-emptive reduction of immunosuppression. We need prospective and controlled studies to define the impact of EBV monitoring in reducing the risk of PTLD in SOT recipients.
authors: Unit of Infectious Diseases, Instituto de Investigación Hospital 12 de Octubre (i+12), University Hospital 12 de Octubre, Universidad Complutense, Madrid, Spain. Electronic address: rafasjg@yahoo.es.
authors: R
authors: R
authors: San-Juan
authors: Transplantation Centre and Service of Infectious Diseases, University Hospital of Lausanne, Lausanne, Switzerland.
authors: O
authors: O
authors: Manuel
authors: Transplantation & Clinical Virology, Department Biomedicine, Infectious Diseases & Hospital Epidemiology, University of Basel, Basel, Switzerland.
authors: H H
authors: HH
authors: Hirsch
authors: Unit of Infectious Diseases, Instituto de Investigación Hospital 12 de Octubre (i+12), University Hospital 12 de Octubre, Universidad Complutense, Madrid, Spain.
authors: M
authors: M
authors: Fernández-Ruiz
authors: Unit of Infectious Diseases, Instituto de Investigación Hospital 12 de Octubre (i+12), University Hospital 12 de Octubre, Universidad Complutense, Madrid, Spain.
authors: F
authors: F
authors: López-Medrano
authors: Pediatric Haematology-Oncology and Research Laboratories Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
authors: P
authors: P
authors: Comoli
authors: Nephrology and Transplantation Department, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.
authors: S
authors: S
authors: Caillard
authors: National Centre for Transplantation, Infectious and Tropical Diseases Department, University of Insubria, Varese, Italy.
authors: P
authors: P
authors: Grossi
authors: Unit of Infectious Diseases, Instituto de Investigación Hospital 12 de Octubre (i+12), University Hospital 12 de Octubre, Universidad Complutense, Madrid, Spain.
authors: J M
authors: JM
authors: Aguado
mesh_terms: D003430:Cross-Sectional Studies; D020031:Epstein-Barr Virus Infections / Q000150:complications* / Q000175:diagnosis / Q000517:prevention & control* / Q000628:therapy; D005060:Europe; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D008232:Lymphoproliferative Disorders / Q000175:diagnosis / Q000517:prevention & control* / Q000628:therapy; D016377:Organ Transplantation; D049268:Positron-Emission Tomography; D000069283:Rituximab / Q000008:administration & dosage; D011795:Surveys and Questionnaires; D058570:TOR Serine-Threonine Kinases / Q000037:antagonists & inhibitors; D014057:Tomography, X-Ray Computed; D066027:Transplant Recipients; D019562:Viral Load; D014766:Viremia / Q000175:diagnosis
chemical_list: D007166:Immunosuppressive Agents; D000069283:Rituximab; D058570:TOR Serine-Threonine Kinases
keywords: Epstein–Barr virus; Europe; post-transplant lymphoproliferative disease; pre-emptive treatment; survey