title: Late Persistent Positive EBV Viral Load and Risk of Solid Cancer in Kidney Transplant Patients.
abstract: Recent studies reported that posttransplant Epstein-Barr virus (EBV) replication is frequent and indicates overimmunosuppression. We hypothesized that long-term EBV replication may identify overimmunosuppressed patients at higher risk of cancer.
  
  
  
  We analyzed a prospective cohort of renal transplant recipients having routine EBV PCR surveillance. All cancers (except EBV-related neoplasia) were recorded.
  
  
  
  Mean follow up was 94 + 23 months. Samples (8412) were available in 669 patients. Three hundred eighty-eight of the 669 patients (58%) had at least 1 positive viremia during follow-up.Epstein-Barr virus D+/R- patients (P = 0.046) as well as those having received antithymocyte globulin (P < 0.001) were more likely to develop persistent EBV viremia. Eighty-six patients (12.9%) developed a cancer during follow-up. The cumulated incidence of cancer was higher in patients with persistent high EBV replication (22.4% vs 10.2%, P = 0.005). The effect of persistent EBV infection remained significant even after adjustment for all confounding factors (hazard ratio, 1.69; 95% confidence interval, 1.10-2.61; P = 0.018). Age, history of antithymocyte globulin use, smoking, and history of cancer were also associated with cancer occurrence.
  
  
  
  Persistent high EBV viral load is associated with the occurrence of solid cancer. In this setting, more intensive screening and/or minimization of immunosuppressive treatment are probably required.
authors.affiliation: 1 INSERM, UMR1098, Federation Hospitalo-Universitaire INCREASE, Besançon, France. 2 Department of Nephrology, Dialysis, and Renal Transplantation, CHU Besançon, Besançon, France. 3 Department of Virology, CHU Besançon, Besançon, France. 4 Department of Nephrology, Dialysis, and Renal Transplantation, CHU Dijon, Dijon, France.
authors.forename: Jamal
authors.initials: J
authors.lastname: Bamoulid
authors.forename: Cécile
authors.initials: C
authors.lastname: Courivaud
authors.forename: Alain
authors.initials: A
authors.lastname: Coaquette
authors.forename: Thomas
authors.initials: T
authors.lastname: Crépin
authors.forename: Clémence
authors.initials: C
authors.lastname: Carron
authors.forename: Emilie
authors.initials: E
authors.lastname: Gaiffe
authors.forename: Caroline
authors.initials: C
authors.lastname: Roubiou
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Rebibou
authors.forename: Didier
authors.initials: D
authors.lastname: Ducloux
mesh_terms: D000328:Adult; D000367:Age Factors; D000961:Antilymphocyte Serum / Q000009:adverse effects; D020031:Epstein-Barr Virus Infections / Q000175:diagnosis / Q000453:epidemiology / Q000276:immunology / Q000821:virology*; D005260:Female; D005602:France / Q000453:epidemiology; D004854:Herpesvirus 4, Human / Q000254:growth & development* / Q000276:immunology; D006801:Humans; D016867:Immunocompromised Host; D007166:Immunosuppressive Agents / Q000009:adverse effects; D015994:Incidence; D053208:Kaplan-Meier Estimate; D016030:Kidney Transplantation / Q000009:adverse effects*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009369:Neoplasms / Q000175:diagnosis / Q000453:epidemiology / Q000276:immunology / Q000821:virology*; D009894:Opportunistic Infections / Q000175:diagnosis / Q000453:epidemiology / Q000276:immunology / Q000821:virology*; D016016:Proportional Hazards Models; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects; D013997:Time Factors; D016896:Treatment Outcome; D019562:Viral Load; D014779:Virus Replication
chemical_list: D000961:Antilymphocyte Serum; D007166:Immunosuppressive Agents