title: Primary Epstein-Barr virus infection, seroconversion, and post-transplant lymphoproliferative disorder in seronegative renal allograft recipients: a prospective cohort study.
abstract: BACKGROUND
  Epstein-Barr virus (EBV)-seronegative renal transplant recipients are at risk of post-transplant lymphoproliferative disorder (PTLD). We compared primary EBV infection, seroconversion, and PTLD in EBV-seronegative patients who received renal allograft from seropositive or seronegative donors (D+/R- and D-/R-, respectively).
  
  
  METHODS
  We prospectively followed 25 D+/R- and 8 D-/R- recipients. We followed patients from January 1999 to June 2009 with clinical visits, monthly EBV polymerase chain reaction tests, and serologic tests for a period of 1 year after kidney transplantation and on an individual basis thereafter.
  
  
  RESULTS
  Three patients (9%) developed PTLD including 2 early-onset (<12 months) and 1 late-onset (>12 months) disease. In D+/R- and D-/R- patients, the frequencies of PTLD (8% vs. 12.5%, P = 0.7), EBV seroconversion (64% vs. 50%, P = 0.4), and EBV viremia (40% vs. 25%, P = 0.6) were not significantly different. Clinical, serologic, and virologic surveillance as well as reduction in immunosuppression after evidence of primary EBV infection resulted in a PTLD rate of 9%, despite a seroconversion rate of 60.6%. Rate of graft loss after reduction in immunosuppression was 10% (2 of 20), which was not significantly different from 13 patients without EBV seroconversion (no graft loss, P = 0.5). Rates of viremia, seroconversion, and PTLD in D+/R- and D-/R- patients appear to be similar.
  
  
  CONCLUSIONS
  The incidence of PTLD in renal transplants ranges from 0.5% to 2.9%. Our data show a significantly higher rate in EBV-seronegative renal allograft recipients, suggesting the need for close surveillance. Our data also suggest that donors for EBV-seronegative recipients may be accepted irrespective of positive or negative serostatus, with ongoing surveillance important in either circumstance.
authors.affiliation: Multi-organ Transplant Program, University Hospital, London, Ontario, Canada.|Program of Experimental Medicine, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.|Division of Infectious Diseases, Western University, London, Ontario, Canada.
authors.forename: S M
authors.initials: SM
authors.lastname: Hosseini-Moghaddam
authors.affiliation: Department of Nephrology, King Fahad Hospital, Medinah Munawrah, Saudi Arabia.
authors.forename: B
authors.initials: B
authors.lastname: Alhomayeed
authors.affiliation: Department of Obstetrics and Gynecology, University of Calgary, Calgary, Alberta, Canada.
authors.forename: N
authors.initials: N
authors.lastname: Soliman
authors.affiliation: Multi-organ Transplant Program, University Hospital, London, Ontario, Canada.|Program of Experimental Medicine, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.|Division of Nephrology, Western University, London, Ontario, Canada.|Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada.
authors.forename: M A
authors.initials: MA
authors.lastname: Weir
authors.affiliation: Multi-organ Transplant Program, University Hospital, London, Ontario, Canada.|Program of Experimental Medicine, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.|Division of Nephrology, Western University, London, Ontario, Canada.
authors.forename: A A
authors.initials: AA
authors.lastname: House
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D020031:Epstein-Barr Virus Infections / Q000276:immunology* / Q000821:virology; D005260:Female; D004854:Herpesvirus 4, Human / Q000276:immunology*; D006801:Humans; D007165:Immunosuppression Therapy; D007668:Kidney / Q000276:immunology / Q000601:surgery / Q000821:virology; D016030:Kidney Transplantation / Q000009:adverse effects*; D008232:Lymphoproliferative Disorders / Q000209:etiology* / Q000276:immunology; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000276:immunology* / Q000821:virology; D011446:Prospective Studies; D000069078:Seroconversion; D014184:Transplantation, Homologous / Q000009:adverse effects; D014766:Viremia
keywords: Epstein-Barr virus infection; immunosuppression; kidney transplantation; post-transplant lymphoproliferative disorder